Utilization Review Specialist

Praesum Healthcare:
Position Title: Utilization Review Specialist

Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers in key geographical locations throughout the Northeast, mid-Atlantic, and Southeast regions. Praesum is an established leader in the healthcare industry. With a solid, growth-focused business model, strong finances, and expert management team, Praesum will continue to grow in the years to come. Praesum currently provides services to behavioral health facilities providing all levels of care from inpatient psychiatric and substance abuse detoxification, through SUD and mental health outpatient clinics.


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 ***