Utilization Review Specialist Position Available In Wake, North Carolina

Triangle Springs Utilization Review Specialist (Full-Time/40 hours)

Who We Are:

At Triangle Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you’ll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve. Our programs offer customized rehabilitation tailored to the specific needs of those recovering from a stroke, brain injury, neurological conditions, trauma, spinal cord injury, amputation or orthopedic injury.

Why Choose Us:

Affordable medical, dental and vision plans provided to meet the needs of full-time employees and their families Competitive Paid Time Off Tuition reimbursement, continuing education opportunities and apprenticeship programs for eligible employees 401(K) retirement plans Flexible spending and health savings accounts And much more€¦ How you’ll contribute: The Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. The Utilization Review Specialist advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment. The Utilization Review Specialist contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.

Essential Functions:

™¦ Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services ™¦ Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource. ™¦ Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations. ™¦ Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.

Qualifications:

™¦ Bachelor’s degree Required, master’s degree Preferred. ™¦ Previous utilization review experience in a psychiatric healthcare facility preferred. ™¦ Current unencumbered clinical license strongly preferred ™¦ CPR certification and Crisis Prevention Training (CPI) preferred.

EEOC Statement:

Triangle Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status or any other basis protected by applicable federal, state or local law.