Utilization Review Specialist

Utilization Review Specialist

Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time.

Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on society's most vulnerable population, Parkside provides world-class mental health services for youth and adults. For over 65 years, Parkside's physicians, therapists, and staff have provided state of the art, patient-centered care that propels families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time.

We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist assesses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.

Responsibilities:

• Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.
• Communicates with clinicians regarding discharge issues relevant to patient's pay source. Tracks due dates for authorization reviews and alerts clinicians.
• Communicates with clinicians regarding admissions and discharges to various units.
• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.
• Coordinates/completes the appeal process for authorization denials
• Performs audits of clinical services to ensure compliance with standards of third party pay sources and agency policies.
• Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.
• Maintains a good working relationship within the department and with other departments.
• Documentation meets current standards and policies.
• Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.
• Orients new staff members to the unit
• Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed
• Performs other duties as assigned

Qualifications

• Bachelor's degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
• 2yrs minimal experience in health care, utilization review and business setting

Benefits include:

• Medical, Dental, and Vision
• Generous Paid Time Off and Holidays
• 401K and match start immediately, and includes a generous match
• Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer!

Parkside Psychiatric Hospital & Clinic