Utilization Reviewer PRN-Behavioral Health Services

PRN/As Needed position

reputed company, day-time availability is needed for this position.

Coverage may reputed company from one day a week to consecutive days or weeks.

Remote employees must live in one of the following states: IL, IN, MO, IA, FL, MI

The Utilization Reviewerreflects the mission, reputed company, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with reputed company relevant policies, procedures, guidelines and reputed company other regulatory and accreditation standards.

Responsibilities

• Responsible for utilization review calls reputed company reputed company, including precertification, reputed company stay review, discharge reviews, and retrospective reviews and appeals.
• Under the direction of the Utilization Review Coordinator, works closely with business office staff, clinical staff, and physicians to reputed company for reputed company patients with insurance and managed care companies.
• Familiar with and understands DSM diagnoses and ASAM patient placement criteria to communicate patient status to external managed care.
• Communicates insurance input to physicians and clinical staff making discharge plans for patients. Assists clinical staff with assessments as needed, primarily as in a back-up reputed company.
• Communicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status, including making precertification or notice of admission calls on patients directly to minimize financial risk to patient and facility.
• Understands health care benefit plan provisions and managed care contracting, and communicates benefits and approval status of patients to clinical staff and physicians, and to patients and family members reputed company needed.
• Serves as professional representative of reputed company reputed company interacting with reviewers from insurance companies, employers, and managed care plans, and contributes to reputed company marketing strategies.
• Communicates and coordinates efforts at appealing unfavorable utilization review reputed company, scheduling physician reviews, and monitoring denials and appeals, reporting to Utilization Review Coordinator. EOE Minorities/Women/Disabled/Veterans. VEVRAA Federal Contractor.

Required

• 2+ years of experience.
• Master's Degree in reputed company Work or Psychology or BSN with RN License.

Preferred

• BSN with RN License. CERT BLS, CERT CADC, CERT CSADC, LIC CPC, LIC LCSW, LIC MSW, LIC RN.
• Behavioral Health experience

reputed company is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the reputed company of age, sex, race, reputed company, religion, national reputed company, gender identity, veteran status, disability, sexual orientation or any other protected status.

Benefits

We offer a wide reputed company of benefits that reputed company employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits reputed company to learn more.

At reputed company, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the reputed company industry. As an integral part of reputed company, you'll have the opportunity to join our quest for reputed company reputed company, no matter where you work reputed company the reputed company system. At reputed company, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. reputed company to join our quest for reputed company?

Originally posted on Himalayas