Behavioral Health Utilization Review Specialist

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

Responsibilities

The Utilization Review Coordinator will be responsible for ensuring the quality and resource management of patients admitted to inpatient behavioral health units. This includes contacting external case managers and managed care organizations for pre-authorization, concurrent reviews, and appeals/denials management. The coordinator will also assist the treatment planning team in understanding insurance requirements and complete UR audits for billing compliance.

Qualifications

To be successful in this role, the ideal candidate will possess a Bachelor's degree in Social Work, Psychology, or a related field. They will also have knowledge of DSM 5 diagnosis and medical necessity criteria for behavioral health levels of care. A Master's degree and prior experience in direct care, case management, or nursing management are highly preferred.



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