Utilization Review Specialist
2 weeks ago
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.
- 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.
- 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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Utilization Review Coordinator
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Smyrna, Georgia, United States Ridgeview Institute Smyrna Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at Ridgeview Institute Smyrna. As a Utilization Review Coordinator, you will play a critical role in ensuring that our patients receive the necessary care and services to achieve their treatment goals.Key ResponsibilitiesConduct thorough reviews of patient treatment...
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