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Clinical Utilization Specialist

2 months ago

Nashville, Tennessee, United States Newport Healthcare Full time
About the Role

Newport Healthcare is a leading provider of behavioral healthcare services, dedicated to delivering high-quality care to young people and their families. We are seeking a skilled Clinical Utilization Specialist to join our team, responsible for managing an active caseload of clients and ensuring seamless communication with insurance companies, clinical teams, and families.

Key Responsibilities
  • Case Management: Coordinate and schedule reviews to ensure continuous coverage, utilizing clinical information and knowledge of medical necessity criteria.
  • Review Coordination: Conduct and manage initial, concurrent, and discharge reviews to optimize benefits and utilization, representing the Utilization Review Department in a professional and positive manner.
  • Client Communication: Maintain contact with clients' families and keep them updated on current insurance authorization updates, peer reviews, and denials.
  • Documentation: Document all activities in a detailed manner in applicable CRM/EMR systems.
  • Collaboration: Collaborate with clinicians and the multidisciplinary team daily to obtain necessary clinical documentation for reviews and ensure effective utilization of resources.
  • Meetings and Reporting: Participate in weekly treatment team and continuing care meetings, prepare and submit appeal documentation, and complete weekly treatment team notes.
Requirements
  • At least two (2) years of work experience in the behavioral health field.
  • Active license or credential in a behavioral health field preferred.
  • Bachelor's or Master's degree in a behavioral health-related specialty preferred.