Behavioral Health Utilization Review Specialist

1 month ago


Boonton, New Jersey, United States St. Clare's - Boonton Full time
Overview:

At St. Clare's Health, our dedicated team of professionals is committed to delivering high-quality, compassionate care to our patients and their families.

As a member of Prime Healthcare, St. Clare's Health is seeking a skilled Behavioral Health Utilization Review Specialist to join its award-winning team.

The successful candidate will be responsible for ensuring the quality and resource management of all patients admitted to inpatient behavioral health units, from admission to discharge.

Key responsibilities include contacting external case managers and managed care organizations for pre-authorization, concurrent reviews, and appeals/denials management.

The ideal candidate will possess a strong understanding of insurance requirements and be able to complete UR audits for billing compliance.

The methodology is designed to facilitate and ensure the achievement of quality, clinical, and cost-effective outcomes.

Responsibilities also include assisting the treatment planning team in understanding insurance requirements and completing UR audits for billing compliance.

The successful candidate will be a team player with excellent communication and interpersonal skills.

St. Clare's Health is an equal employment opportunity employer and prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age, disability, military status, genetic information, or any other basis protected by applicable federal, state, or local laws.

The Company also prohibits harassment of applicants or employees based on any of these protected categories.

For more information, please visit our website.



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