Clinical Utilization Specialist

2 weeks ago


Harlingen, Texas, United States Summit BHC Full time
Job Title: Clinical Utilization Specialist

At Summit BHC, we are seeking a highly skilled Clinical Utilization Specialist to join our team. As a Clinical Utilization Specialist, you will play a critical role in ensuring that our patients receive the necessary care and services to achieve optimal health outcomes.

Key Responsibilities:
  • Conduct thorough reviews of patient admissions, continued stays, and discharges to ensure medical necessity and compliance with regulatory requirements.
  • Communicate effectively with insurance companies, health maintenance organizations (HMOs), and other payers to obtain authorizations and resolve any issues related to patient care.
  • Collaborate with healthcare providers to ensure that patients receive the necessary care and services to achieve optimal health outcomes.
  • Develop and maintain accurate and comprehensive documentation of patient care and treatment plans.
  • Participate in quality improvement initiatives to identify areas for improvement and implement changes to enhance patient care and outcomes.
Requirements:
  • Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field.
  • Two or more years of direct clinical experience in a psychiatric or mental health setting.
  • Current licensure as an LPN or RN or current clinical professional license or certification, as required, within the state where the facility provides services.
Why Join Our Team?

At Summit BHC, we offer a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. We are committed to providing our employees with a supportive and inclusive work environment that fosters growth and development. If you are a motivated and compassionate individual who is passionate about delivering high-quality patient care, we encourage you to apply for this exciting opportunity.



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