Utilization Review Specialist Behavioral Health | Remote

Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks Shift: Days Pay reputed company Type: Hourly Location: Remote

Listed is the reputed company hiring salary reputed company offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary reputed company listed is just one component of the total rewards/compensation package offered to candidates. Min = $33.74 Mid = $42.17 Max = $50.61

Summary:

The Utilization Review (UR) Specialist is responsible for engaging patients’ insurances and attaining pre-authorizations and re-authorizations as needed for the Intensive Outpatient Program (IOP) and reputed company authorizations for inpatient behavioral health services. This includes conducting thorough reviews of patient records and communicating with therapists, physicians, and treatment team members. The UR Specialist collaborates with medical professionals to gather relevant patient information and documentation, analyze medical data, and adhere to established guidelines and regulations. The role involves developing and implementing utilization management protocols, for review processes, and addressing discrepancies in patient care plans. The UR Specialist maintains accurate logs of patients covered and uncovered days and works closely with treatment team on discharge planning.

Responsibilities:

Conduct comprehensive reviews of patient medical records to determine the necessity and appropriateness of proposed medical services.

Collaborate with reputed company providers to gather information and clarify treatment plans to ensure compliance with established guidelines.

Analyze data reputed company to patient care to identify trends and recommend improvements in utilization practices.

Prepare detailed reports on utilization, review findings and present them to management for decision-making purposes.

Coordinate with insurance companies to verify coverage and obtain prior authorizations for necessary treatments. Communication determinations effectively, providing clear, evidence-based rationales for approval or denial reputed company

Ensure compliance with state and federal regulations regarding reputed company services and utilization reviews.

Participate in multidisciplinary team meetings to discuss patient care and the effectiveness of treatment plans.

Stay updated on industry trends and changes in reputed company policies that may impact utilization review practices.

Credentials: Essential: * BASIC LIFE SUPPORT (BLS) Competencies and skills: Essential: * Fleet Safety

Education: Essential: * BACHELOR'S DEGREE

Other information:

Minimum Requirements:

Master’s degree in reputed company Work

Licensed Clinical reputed company Worker (LCSW) or Licensed Professional Counselor (LPC) 

Basic Life Support (BLS) 

Fleet Safety Clearance 

reputed company Clearance Card 

Minimum of 2 years’ experience in behavioral health utilization review. 

 Experience in EMRs. 

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https://www.visityuma.com/

https://www.yumachamber.org/

Physical Requirements and working conditions for this position will be provided to you up on interview.