UM Specialist New Vista Behavioral Health - 2.4 Cincinnati, OH Job Details Full-time $24 - $32 an hour 17 hours ago Benefits Paid holidays Disability insurance Health insurance Dental insurance Tuition reimbursement Paid time off Vision insurance 401(k) matching Loan forgiveness Qualifications Appeals Case appeal in utilization management Insurance claims appeal handling

Full Job Description UM Specialist Pay:

$24 - $32hr

Location:

10123 Alliance Road, Cincinnati, Ohio 45242

Schedule:

Full Time Who we are At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery. The Role Itself The Utilization Management Appeals Specialist is responsible for the appeals of denied claims for Inpatient and Outpatient Services. This includes writing clinical justification for admission and continued stay criteria based on clinical documentation in the patient record. The UM Appeals Specialist will accurately report the appeals status to the Corporate Director of UM. The UM Appeals Specialist will follow department and department procedures and ensure effective communication with all relevant departments regarding patient care needs. Oversees the appeals process for all denied claims on assigned caseload. Reviews the medical record to identify clinical criteria for an appeal completion and submission. Maintains an active involvement and awareness of all denials on their caseload to include appeals status Oversees the coordination with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals. Maintains logs of all denials along with updated status of same. Other Duties as assigned

Job Requirements:

Bachelors Degree in Nursing, Social Work, or related field preferred Must be 21 or older 2 yrs exp in healthcare setting writing clinical or medical necessity appeals.

LPN, RN, LSW, LPC

are applicable licenses for this role. Why You'll Love It Here (Full‑Time Benefits)

• Multiple medical plan options, Vista Wellness (physician/pharmacy), Dental, Vision
• Generous PTO and paid holidays
• 401(k) with company contribution; Life and disability coverage
• Tuition reimbursement up to $15,000 and student loan forgiveness programs