Utilization Review Specialist

Summary:

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The Utilization Review Specialist is responsible for obtaining initial and continued authorization for clients in our partial hospitalization and intensive outpatient eating disorder program. The ideal candidate will have a strong understanding of utilization review processes and be able to effectively communicate with insurance companies. This individual is expected to advocate for clients to obtain authorization for the services they need.

 

 

Responsibilities:

  • Obtain a Verification of Benefits for clients as they enter the program and screen for preauthorization requirements
  • Work with the treatment team to obtain enough information for initial and concurrent authorizations
  • Write utilization reviews for documentation and insurance purposes
  • Present clinical information to insurance companies for initial and continued authorization through verbal and written means, depending on the insurance company’s requirements
  • Track Initial Authorizations, Utilization Reviews, and other insurance-related items and ensure timely followup
  • Respond to insurance company inquiries and appeals, including live peer reviews as needed
  • Track and monitor utilization review trends and present them to the treatment team as needed
  • Stay up-to-date on changes to insurance company policies and procedures
  • Collaborate with other members of the clinical team to ensure a coordinated approach to patient care

 

 

Qualifications:

  • Preferred: Bachelor’s degree in a related field (e.g., nursing, social work, psychology)
  • 2+ years of experience in utilization review or a related field
  • Strong understanding of medical terminology, behavioral health medical necessity, and insurance company policies and procedures
  • Excellent written and verbal communication skills
  • Ability to work independently and as part of a team
  • Ability to meet deadlines and manage multiple projects simultaneously

 

 

Benefits

  • Competitive pay
  • Opportunity to work with a talented team of professionals
  • Chance to make a difference in the lives of others
  • Work-life balance and personal growth opportunities
  • Fully remote work

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