Utilization Review (UR) Specialist
NewVista Behavioral Health
UR Specialist
Shift: M-Fr 8-5
This is not a remote position. It is an office-based position in Cincinnati, Ohio.
At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.
The Role Itself
Position Summary: The Utilization Review Specialist is responsible for the authorizations and certifications process for Inpatient and Outpatient Services. This includes the precertification and recertification process, peer to peer reviews, and appeal. The UR Specialist will accurately report the authorization status of patients, denials and appeals status to the Corporate Director of UR. The UR Specialist will follow department and department procedures and ensure effective communication with all relevant departments regarding patient care needs.
Job Responsibilities
As Utilization Review Specialist, you will :
- Obtain Continued Stay Reviews for Inpatient and Outpatient behavioral health treatment.
- Follow up on prior authorization submissions that need further information to obtain authorization.
- Display knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization, and advocates on behalf of the patient to secure coverage for needed services.
- Strong working knowledge of external review organizations (ie: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
- Report appropriate denial and authorization information to designated resource.
- Coordinate authorization information with third party payors in a timely manner.
- Complete thorough and accurate documentation in all required systems.
- Maintain communication system based on documentation and verbal exchange regarding treatment with other UM staff and staff at the facilities as needed.
- Schedule and follow up on results of Peer to Peer requests for physicians and CNP.
- Maintain Denial Log
Education
- High school diploma or GED (Required), Bachelor's Degree or Master's Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field preferred.
- Previous Utilization Review experience in a behavioral healthcare facility preferred.
- License : LPN, RN, LSW, LPC, LCDC or applicable license preferred
Skills
- Ability to multi-task
- Strong organization skills
- Strong problem-solving skills
- Ability to work well independently and as part of a team
Perks at Work
Healthcare :
- Medical Packages with Rx 3 Choices
- Flexible Spending Accounts (FSA)
- Dependent Day Care Spending Accounts
- Health Spending Accounts (HSA) with a company match
- Dental Care Program 2 choices
- Vision Plan
- Life Insurance Options
- Accidental Insurances
- Paid Time Off + Paid Holidays
- Employee Assistance Programs
- 401k with a Company Match
Education + Leadership Development :
- Up to $15,000 in Tuition Reimbursements
- Student Loan Forgiveness Programs
Our overall mission is to Inspire Hope, Restore Peace of Mind and Heal Lives.
NewVista Behavioral Health- ...Utilization Review Coordinator New Vista Health and Wellness is currently recruiting a Utilization Review Coordinator for our team in... ...authorization information to designated resource. Assist UM Specialists in scheduling and following up on results of Peer to Peer...SuggestedFlexible hours
- The University Medical Center, Inc. in Cincinnati is seeking a Utilization Review RN to manage utilization review functions. You will perform evaluations regarding patient admissions and insurance compliance, communicating effectively with physicians and care teams. This...Suggested
- ...Metered Utilities Specialist Are you someone who enjoys research and has a keen eye for detail? Do you enjoy math and equations? Are you... ...whose primary function is to manage customer utilities and rate reviews. Essential Functions Core functional knowledge of...SuggestedLive inWork at officeRemote workRelocationWork visa
$30 - $35 per hour
...Bring projects to life behind the scenes. As a Permit Specialist, you'll play a vital role in keeping utility construction projects moving—supporting gas and... ...applying, you acknowledge and agree that your application may be reviewed using AI tools. #J-18808-Ljbffr ActalentSuggestedContract workTemporary workRemote workWork from homeHome officeFlexible hours- Actalent is seeking a Permit Specialist to support utility construction projects in Bellevue, KY. In this role, you will manage permit applications and ensure compliance with municipal regulations, playing a crucial part in infrastructure development. The ideal candidate...SuggestedRemote workFlexible hours
$54.4k - $111.5k
Principal Review Specialist General Function Performs brokerage and insurance regulatory sales supervision functions for the broker‑dealer and insurance agency subsidiaries of the Bancorp. Mitigates risk of loss and regulatory risk incurred by Fifth Third Securities. Responsible...Work experience placementImmediate start- Fifth Third Bank, N.A. in Cincinnati, Ohio is seeking an Item Processing Specialist to support transaction systems. The role involves fraud prevention and transaction review, requiring attention to detail and strong analytical skills. Candidate must have a high school...Night shift
- A regional airport authority in Cincinnati is seeking a Utility Coordinator to assist in the development and execution of utility operations including shutdowns and maintenance. The role requires a Master Electricians License, at least five years of experience, and involves...For contractors
$21.63 - $25.12 per hour
...process. School Solutions Program Specialist 5 days ago Requisition ID: 130... ...with key school partners and utilizes best-in-class customer service... ...management and compliance review in alignment to company standards... ...Providers in order to meet UR requirement. Education and/or...Full timeWork experience placement- ...processes and requirements. * Brings experience coordinating utility design and construction for State and Local Programs roadway projects... ...design, and construction coordination activities. * Prepare, review, and maintain utility relocation plans; develop accurate...Temporary workFor contractorsLocal areaRelocationRelocation packageFlexible hours
$17 - $18.15 per hour
...Patient Access Specialist Ensemble is a leading provider of technology-enabled revenue... ...receiving, and processing physician orders, and utilizing an overlay tool while providing... ...forms implemented for future services. Reviews eligibility responses in insurance verification...Part timeWork at officeLocal areaRemote workWeekend work$17 - $18.15 per hour
...are searching for the next Patient Access Specialist champion. This role is responsible for... ...receiving, and processing physician orders, and utilizing an overlay tool while providing... ...forms implemented for future services. Reviews eligibility responses in insurance...Part timeWork at officeLocal areaRemote workWeekend work$2,500 per month
...divh2Utilities Coordinator/h2pThe Utility Coordinator supports the Utilities function by assisting in the development, set up, and execution... ..., and maintenance. This position will participate in the review of project plans, as well as close out review to ensure acceptable...Temporary workFor contractorsFlexible hours- ## Senior Specialist, Logistics AdministrationApplylocations: Midwest City, Oklahomatime type... ...of space defense.**Job DescriptionWill utilize engineer drawings, technical orders, and... ...planning; assigning, monitoring, and reviewing progress and accuracy of work; evaluating...
- ...products are globally shipped to customers far and wide. The Utility Technician plays a critical support role across Maintenance,... ...activities, including basic inspection of parts and documentation reviews. Help ensure configuration management principles are followed (...Shift workWeekend work
- ...About The Role: As a Maintenance Specialist with Victory & Equipment Services, you will play... ..., minimize downtime, and maximize asset utilization Build and maintain strong... ...stakeholders throughout the process Review and approve maintenance invoices to ensure...Work at officeImmediate start
$44.3k - $89.42k
...Position Summary: The LCU/R Quoting Specialist supports Trane Supply’s sales and customer... ...requests and specifications • Review RFQs, equipment replacements, and customer... ...appropriate product selection and pricing. • Utilize Trane Supply systems, product selection...Hourly payWork at officeLocal areaWork from home- ...visit Job Title: RCM Medical Coding Specialist SUMMARY The Medical Coding Specialist... ...with legal standards and guidelines. Review medical records and both identify and... ...guidelines. Experience with the utilization of modifiers and other coding rules to include...Work at office
- ...of applicant and participating families utilizing CMHA's software system. Calculate monthly... ...to Housing Choice Voucher Program. Review and process information for both owner... ...The incumbent must possess a housing specialist certification within 12 months of employment...Work at office
$62k - $85k
...standards of care. The Distribution Specialist (Distribution Operations) is responsible... ...rates, and labor productivity. ~ Review performance regularly with 3PL partners... ...operational requirements. ~ Monitor labor utilization, overtime, and productivity, signaling...Temporary workShift workWeekend workAfternoon shift- ...variety of correspondence, reports, forms, and other documents utilizing Microsoft Office applications and CMHA-specific software systems... ...Program while ensuring data integrity and accuracy. • Review and process information related to owner and participant terminations...Work experience placementWork at office
- ...relationships for third party services that are utilized within a particular line of business or... ...Working Groups, periodic business reviews, , and periodic performance meetings for... ...to work with general supervision. Specialist, Third Party Oversight At Fifth Third...Contract workWork at officeShift work
- ...for applicants and participating families utilizing CMHA's software systems while... ...ensuring data integrity and accuracy. • Review and process participant and owner terminations... ...• The incumbent must possess a housing specialist certification within 12 months of employment...Work experience placementInterim roleWork at officeLong distance
- ...: Under moderate supervision the Equity Decision specialist's task is to work with the Equity Review team and assist them with the administrative functions... ...loan delinquencies range from 0 - 180+ days' while utilizing various systems. Files could be early, mid or late...Work at office
- ...Operational Excellence Lean Specialist - Blue Ash, Ohio At Allegion, we help keep the people... ...indicators for functions being reviewed, evaluates current state, and proposes future... ...required in support of the Lean initiatives Utilize value stream mapping techniques to...Temporary workH1b
$129k - $177k
...BC) is seeking a Trenchless Technology Specialist to support planning, design, and construction... ...delivering trenchless and underground utility infrastructure projects (planning... ...laws. For further information, please review the Know Your Rights notice from the Department...Temporary workFor contractorsRemote work- ...Job Description Job Description We’re seeking a Receiving Specialist who will be responsible for unpacking, organizing and processing... ...inventory systems and maintain regular cycle counts. Documentation: Review shipping orders, generate labels, and prepare invoices and...Full timeWork at office
- ...EHS&S Specialist Reporting directly to the EHS&S Manager, the EH&S Specialist is responsible... ...pre-qualification program. Review new chemicals and maintain Peter Cremer... ...opportunities Be cost effective in the utilization of our resources, thereby contributing to...For contractorsWork at officeFlexible hours
$79k - $127.65k
Senior Health Authority Reporting Specialist Job Function: Quality Job Sub Function: Customer... ...Overview This role is responsible for reviewing and processing product complaints, managing... ...procedures and CQ expectations. Utilize MD Workflow reports to identify tasks and...ApprenticeshipLocal areaImmediate start$81.4k - $122k
...Systems has an opening for a Principal Subcontract Specialist to join our team of qualified, diverse individuals... .... Manages and develops strategic/key suppliers. Reviews and approves supplier payment as needed. Utilizes process tools such as Lean Six Sigma with suppliers...Contract workFor subcontractorRelocation packageShift work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review (UR) Specialist. Be the first to apply!
- senior program specialist Cincinnati, OH
- order processing specialist Cincinnati, OH
- correspondence specialist Cincinnati, OH
- instructional systems specialist Cincinnati, OH
- student specialist Cincinnati, OH
- youth engagement specialist Cincinnati, OH
- leave specialist Cincinnati, OH
- promotions specialist Cincinnati, OH
- enterprise solutions specialist Cincinnati, OH
- government information specialist Cincinnati, OH



