Utilization Review Specialist

2 weeks ago


Smyrna, Georgia, United States Ridgeview Institute Smyrna Full time
Job Summary

We are seeking a highly skilled Utilization Review Specialist to join our team at Ridgeview Institute Smyrna. As a key member of our healthcare team, you will be responsible for assessing patient care plans and determining the most cost-effective treatment options.

Key Responsibilities:
  • Review treatment plans and advocate for additional services as needed.
  • Maintain ongoing contact with attending physicians, program managers, and other team members.
  • Collaborate with the treatment team to address continued stay and discharge planning issues.
  • Advocate for patients to be placed in the appropriate level of care and program.
  • Interface with program staff to facilitate a smooth transition during transfer or discharge.
  • Ensure timely completion of insurance reviews and maintain statistical reports.
  • Prepare documentation of significant findings and update denial log statistics.
  • Consult with the business office and admission staff to clarify data and ensure precertification processes are complete.
  • Provide clinical information to managed care companies and other third-party reviewers.
  • Coordinate with insurance company doctors in appeals and denials processes.
  • Research and prepare reports to identify claims-related trends and reimbursement issues.
Requirements:
  • Bachelor's or Master's degree in social work, mental health, nursing, or a related field.
  • Minimum of two years of experience in a healthcare setting or managed care company.
  • Knowledge of case management techniques, patient assessment, and treatment planning.
  • Excellent leadership, negotiation, and customer relations skills.
  • Ability to communicate effectively verbally and in writing.
What We Offer:
  • Competitive hourly rate: $18.00 - $25.00.
  • 401(k) + matching.
  • Health insurance.
  • 100% company-paid life insurance coverage.
  • Vision and dental insurance.
  • Paid time off and holidays.
  • Cafeteria on site with one free meal per day.
  • Employee engagement events.
  • Employee assistance program.
  • Employee recognition program.
  • Free parking.

We are an equal opportunity employer and value a diverse, inclusive workforce. Accommodations are available for applicants with disabilities.



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