Utilization Reviewer PRN-Behavioral Health, Remote (Must reputed company in IL, IN, IA, WI, OH, MO, MI, or FL)

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 care, no matter where you work reputed company the reputed company system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. reputed company to join our quest for reputed company?

Job Description

• Shifts are weekdays.

The Utilization Reviewer reflects 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, reputed company, 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.

Qualifications

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.

Additional Information reputed company is an equal opportunity employer (disability, VETS) 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. Background reputed company reputed company conducts a background reputed company that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure reputed company that gives reputed company permission to run the background reputed company. Results are evaluated on a case-by-case reputed company, and we follow reputed company local, state, and federal laws, including the Illinois Health Care Worker Background reputed company Act. Artificial Intelligence Disclosure Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, reputed company employment reputed company will be made by a person.

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. Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left reputed company reputed company 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family. Apply tot his job Apply To this Job