Clinical Utilization Review Analyst

2 weeks ago


Lake Worth, Florida, United States Praesum Healthcare Full time
Job Overview

Position Title: Clinical Utilization Review Analyst

Praesum Healthcare, established in 2003, specializes in providing administrative support for healthcare providers across key regions in the Northeast, mid-Atlantic, and Southeast. As a recognized leader in the healthcare sector, Praesum is committed to growth and excellence.

Our organization delivers comprehensive services to behavioral health facilities, catering to all levels of care, including inpatient psychiatric treatment and substance use disorder detoxification, as well as outpatient mental health clinics.


Role Responsibilities:

The Clinical Utilization Review Analyst will be responsible for:

  • Initiating pre-certification and ongoing stay authorizations in accordance with ASAM criteria.
  • Engaging directly with facilities to assess patient needs and symptoms.
  • Managing daily census and scheduling for new admissions and concurrent reviews.
  • Entering authorizations and relevant demographic data into the Electronic Health Record (EHR) for billing purposes.
  • Conducting peer-to-peer reviews and coordinating doctor-to-doctor consultations as necessary.
  • Verifying insurance coverage for each patient.
  • Organizing weekend census reports for all detox and residential patients across inpatient facilities.
  • Gathering all necessary clinical documentation for patients requiring pre-certification.

Qualifications:

The ideal candidate will possess:

  • A High School Diploma.
  • A minimum of 3-5 years of experience in utilization review.
  • Proficiency in Microsoft Office applications and general computer literacy.

Work Schedule:

This is a full-time position, Monday through Friday, from 8:30 AM to 5:00 PM.


Compensation and Benefits:

We offer a competitive hourly rate based on experience and location. Full-time employees may be eligible for:

  • Medical, Dental, Vision, and Short-Term Disability insurance options.
  • Medical Flexible Spending Account (FSA) and Dependent Care Account.
  • 401(k) plan with company match up to 5%.
  • Accrued Paid Time Off (PTO).
  • Education reimbursement and opportunities for career advancement.

Please note: This position does not offer visa sponsorship and we are unable to consider applicants from outside the country.



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