Utilization Review Specialist
Praesum Healthcare
Praesum Healthcare:
Position Title: Utilization Review Specialist
Utilization Review Specialist Job description:
Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings. Utilization Review Specialist Duties/Responsibilities:
• Initiate pre-certification and continued stay authorizations based on ASAM criteria
• Communicate directly with facility regarding patients' needs and symptomology
• Maintain daily census scheduling all new admissions and concurrent reviews
• Input of authorizations and appropriate demographic information to EHR for billing purposes
• Completing "peer to peer" reviews and scheduling "Doctor to Doctor" reviews when needed
• Confirm insurance coverage of each patient
• Organize weekend census of all detox and residential patients for all our impatient facilities
• Collect all appropriate clinical data for each patient that requires precertification Utilization Review Specialist Requirements:
• High School Diploma
• A minimum of 3-5 years of utilization review experience.
• Individual must be computer literate with proficiency in Microsoft Office applications. Utilization Review Specialist Schedule:
• Full Time, Friday - Monday (weekends) with potential for bonus
• 8:30am to 05:00pm Utilization Review Specialist Compensation:
• Hourly rate competitive with experience and location Full time employees may be eligible for the following:
• Insurance: Medical, Dental, Vision, and STD options
• Medical FSA and Dependent Care Account
• 401k with company match up to 5%
• Accrued Paid Time Off (PTO)
• Education reimbursement
• Career Advancement Opportunities *** This job does NOT sponsor visa's and we are unable to consider out of country applicants *** #IND123
Vacancy posted 4 days ago
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