Behavioral Health Utilization Review Specialist

5 days ago


Boonton, New Jersey, United States St. Clare's - Boonton Full time
Job Title: Utilization Review Coordinator

At St. Clare's Health, we are committed to delivering high-quality, compassionate care to our patients. As a Utilization Review Coordinator, you will play a critical role in ensuring that our patients receive the necessary care and services to achieve optimal health outcomes.

Responsibilities:
  • Conduct thorough reviews of patient medical records to determine medical necessity and intensity of service
  • Communicate 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 are an equal employment opportunity employer and prohibit 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 protected category. We are committed to creating a diverse and inclusive work environment that values and respects all individuals.



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