Utilization Review Specialist

Praesum Healthcare, founded in 2003, provides administrative services for behavioral health facilities in the Northeast, mid‑Atlantic, and Southeast regions. Praesum supports inpatient psychiatric, substance abuse detoxification, SUD and mental health outpatient clinics.

Position Title: Utilization Review Specialist

Responsibilities

• Initiate pre‑certification and continued stay authorizations based on ASAM criteria
• Communicate directly with facilities regarding patients’ needs and symptomology
• Maintain daily census and schedule all new admissions and concurrent reviews
• Enter authorizations and demographic information into the EHR for billing purposes
• Complete “peer‑to‑peer” reviews and schedule “doctor‑to‑doctor” reviews when needed
• Confirm insurance coverage for each patient
• Organize weekend census of all detox and residential patients for our inpatient facilities
• Collect appropriate clinical data required for precertification

Requirements

• High School Diploma
• 3–5 years of utilization review experience
• Computer literate with proficiency in Microsoft Office applications

Schedule

• Full‑time, Friday – Monday (weekends), including potential for bonus
• 8:30 am to 5:00 pm

Benefits

• Medical, dental, vision, and STD insurance options
• Medical FSA and dependent‑care account
• 401(k) with company match up to 5%
• Accrued paid time off (PTO)
• Education reimbursement
• Career advancement opportunities

This job does NOT sponsor visas and we are unable to consider out‑of‑country applicants.