Utilization Review Specialist

Utilization Review Specialist

Weekly outpatient therapy isn't always enough, and a trip to the ER isn't the only answer. Patients and their families rely on Compass Health Center when in crisis – every day, we help people overcome depression, anxiety, suicidality, obsessions/compulsions, trauma, chronic pain, and other obstacles in order for our patients to live freely.

About This Role

We are seeking a REMOTE Utilization Review Specialist to obtain appropriate insurance authorization for our patients to receive Behavioral Health treatment at high levels of care. The UR Specialist will act as the liaison between the clinical team and the insurance company, facilitating and maintaining insurance approval through a patient's treatment at Compass Health Center. This person will advocate on behalf of the patient to overcome financial barriers to treatment.

Our dedicated operations teams work behind the scenes to bring our shared mission to life. Each department delivers their own set of strengths which empower our clinicians to focus on their expertise, and ultimately perform the meaningful work that we do.

What You'll Do:

• Contacting insurance companies to verify insurance coverage and obtaining approval of treatment as recommended by the clinical team.
• Collaborating with the clinical team to compile treatment plans and supporting clinical documentation.
• Working with all internal departments as necessary, such as Revenue Cycle and Patient Advocates.
• Accurately documenting Electronic Medical Records to reflect approval or denial of treatment authorization.
• Communicating insurance authorizations/denials and insurance needs to appropriate internal staff.
• Scheduling and delivering concurrent authorization reviews as required by individual insurance companies.
• Coordinating physicians' reviews and appeals.

Who You Are:

• Bachelor's Degree (preferred) or relevant experience
• Previous healthcare or insurance experience
• Knowledge of medical terminology and psychiatric criteria
• Have the ability to analyze and communicate clinical information from progress, group and psychiatric chart notes.
• Have the ability to work autonomously and independently while working collaboratively as part of a team
• Have the ability to think critically and make decisions within individual role and responsibility
• Possess strong written and verbal skills
• Have strong organizational and time management skills with ability to manage workload independently
• Have the ability to foster and maintain positive relationships externally and internally
• Familiarity with Microsoft Office, Outlook, and EMR

Compensation $45,000 - $55,000 USD

We are committed to a fair and equitable work environment.

Compass Health Center is a recognized leader in crisis-level mental health, bringing passion, connection, and patient-centered care to the Partial Hospitalization and Intensive Outpatient space (PHP/IOP). Based in Chicagoland, we serve hundreds of patients every day, ranging from ages 5 through adulthood, in our onsite facilities or through our flourishing virtual programming. Compass fills a critical gap between outpatient and inpatient care through an intermediate level of Behavioral Healthcare.

Our values are super important to us, and hopefully will be to you, too. Cultural humility, teamwork, continuous improvement, connection, patient centered care, passion, innovation, and agility should be your power sources. Joining Compass is an opportunity to feel fulfilled through a joint mission towards healing our communities.

We know that you will be dedicated to your purpose here. We look at that investment as a two-way street. We are proud to offer plenty of space for growth, and opportunities to pursue continuous development within our organization.

For eligible positions, our other benefits include: comprehensive medical/dental/vision plans, 401k program with company matching, generous PTO (including competitive parental leave after 1 year of employment), and continuous training through CEU seminars and volunteering opportunities.

Compass is committed to cultivating diverse and dynamic teams who exude passion for their craft, so whether or not you check all the boxes, we encourage you to apply – we'd be grateful to hear from you!