Behavioral Health Utilization Review Specialist

13 hours ago


Lakewood, New Jersey, United States Saint Clare's Health Full time
Overview

Saint Clare's Health is committed to delivering high-quality, compassionate care to the communities we serve. As a Utilization Review Coordinator, you will play a critical role in ensuring that our patients receive the necessary care and resources to achieve optimal outcomes.

Responsibilities
  • Conduct thorough reviews of patient medical records to ensure medical necessity and intensity of service
  • Collaborate with external case managers and managed care organizations to obtain pre-authorization and manage concurrent reviews
  • Assist the treatment planning team in understanding insurance requirements and complete UR audits for billing compliance
Qualifications
  • Bachelor's degree in Social Work, Psychology, or other health-related field
  • Knowledge of DSM 5 diagnosis and medical necessity criteria for behavioral health levels of care
  • Knowledge of basic psychological and medical terminology

We offer a dynamic and supportive work environment, with opportunities for professional growth and development. If you are passionate about delivering exceptional patient care and are committed to our core values of quality, compassion, and community, we encourage you to apply for this exciting opportunity.


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