Clinical Utilization Specialist

15 hours ago


Miami Florida, United States Monte Nido & Affiliates, LLC Full time
About the Role

We are seeking a skilled Utilization Review Clinician to join our team at Monte Nido & Affiliates, LLC. As a Utilization Review Clinician, you will play a critical role in ensuring that our patients receive the highest level of care and support.

Key Responsibilities
  • Conduct thorough utilization reviews, peer reviews, and pre-certifications to ensure that patients receive the most appropriate level of care.
  • Document reviews and coordinate with the clinical team, admissions, verifications, and billing to ensure seamless communication and care coordination.
  • Develop and maintain relationships with payors to ensure that our patients receive the necessary authorization and support.
  • Stay up-to-date with the latest payor trends, medical necessity criteria, and market developments to ensure that our patients receive the best possible care.
Requirements
  • Master's degree from an accredited program in social work, clinical counseling, nursing, nutrition, or equivalent.
  • Independent State license or independent license eligible (LICSW, LMHC, LPC, Ph.D., RN, RD, LPN or equivalent active Independent Professional Licensure).
  • 1+ years' experience in behavioral health utilization review.
  • 2+ years' experience providing direct clinical care in a mental health setting, preferably with eating disorders in higher levels of care.
About Us

Monte Nido & Affiliates, LLC is a leading provider of treatment for eating disorders. We offer a comprehensive and personalized approach to care, blending medically sophisticated treatment with a supportive and nurturing environment. Our team is dedicated to providing the highest level of care and support to our patients and their families.


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