Utilization Review Specialist

Utilization Review Specialist 4.8 4.8 out of 5 stars 8040 Corporate Cir, North Royalton, OH 44133 $55,000

• $65,000 a year
• Full-time Stepping Stone Outpatient Behavioral Health 12 reviews $55,000
• $65,000 a year
• Full-time Job Summary We are seeking a proactive and detail-oriented Utilization Review Specialist to join our dynamic behavioral health team.

In this vital role, you will evaluate medical necessity, review patient records, and coordinate with healthcare providers to ensure efficient utilization of services. Your expertise will help optimize client care while maintaining compliance with industry standards and regulations. This position offers an exciting opportunity to contribute to improving behavioral health outcomes through meticulous review processes and effective communication. Duties Assist in resolving billing discrepancies and support office operations related to utilization management. Participates in performance improvement activities, exhibit initiative by suggesting process changes with compliance supported by direct observation, meeting minutes, input into supervision process, and staff growth and development survey. Perform pre-certification with third party payers in a professional manner as evidenced by direct observation and review of days approved through monthly monitoring. Perform pre-certification with third party payers in a professional manner as evidenced by direct observation and review of days approved through monthly monitoring. Communiacte to staff the needs of third party payers in relation to case management and assist with documentation in service as evidenced in observation of technique in meetings. Assists in admission review, concurrent review and participates in discharge planning as well as assist in the assignment of length of stay as demonstrated in census meetings and weekly case reviews. Assist providers in peer review by serving as an information resource, gathering data to support review, and scheduling peer to peer reviews. Keeps administration and clinical advised of current client status in regard to utilization review activities. Prepares and maintains reports for and attends meetings as required. Participates in ongoing educational programs in relation to third party payer trends as well as current treatment data. Acts as the client advocate and handles client/family complaints appropriately and according to policy. Monitor client charts and assist with documentation completion and due dates. Requirements Active Licensed Clinicain (LCDC/LSW) Proven experience in managed care environments, behavioral health preferably with a focus on utilization review or case management. Strong knowledge of behavioral health terminology, medical records management, and medical coding practices including CPT, ICD-9, ICD-10, and ICD coding systems. Familiarity with HIPAA regulations to ensure confidentiality and secure handling of protected health information (PHI). At least two years of clinical experience in the MH/SUD field. Experience verifying insurance benefits and authorizations within a behavioral healthcare setting. Experience working with precertification, authorizations, single case agreements and insurance company requirements. Excellent organizational skills with the ability to manage multiple cases efficiently while maintaining attention to detail. Effective communication skills for liaising with healthcare providers, insurance representatives, and patients. Office experience that demonstrates proficiency in documentation, data entry, and use of electronic health record (EHR) systems is preferred. CPR and Handle with Care(HWC) within 30 days of employment. Join us in making a difference by ensuring that patients receive appropriate care while supporting the operational excellence of our behavioral healthcare services!

Pay:

$55,000.00

• $65,000.

00 per year

Benefits:

401(k) matching Dental insurance Disability insurance Employee assistance program Health insurance Life insurance Paid time off Professional development assistance Tuition reimbursement Vision insurance Application Question(s): Do you have a current CDCA, LCDC, LSW or LPC license Do you have at least 2 years of experience of insurance verification? Do you have any issues adhering to a drug free work place? Do you have at least 2 years of experience completing behavioral health priorauthorizations?

Work Location:

In person