Utilization Reviewer PRN - Behavioral Health Services - Remote

Overview

The Utilization Reviewer plays a crucial role in ensuring that patient care aligns with healthcare standards and regulations, advocating for patients and collaborating with healthcare professionals.

In Short

• Conducts utilization review calls for Behavioral Health Services.
• Works with clinical staff and insurance companies to advocate for patients.
• Familiar with DSM diagnoses and ASAM placement criteria.
• Communicates insurance status to clinical staff and assists in discharge planning.
• Handles precertification and appeals processes.
• Represents Behavioral Health Services in interactions with insurance reviewers.
• Monitors denials and appeals, reporting to the Utilization Review Coordinator.
• Requires 2+ years of experience in the field.
• Preferred qualifications include a Master's Degree in Social Work or Psychology.
• Offers competitive benefits including tuition reimbursement and loan forgiveness.

Requirements

• 2+ years of experience in utilization review or related field.
• Master's Degree in Social Work or Psychology or BSN with RN License.
• Behavioral Health experience is preferred.
• Certifications such as BLS, CADC, or LCSW are advantageous.

Benefits

• Tuition reimbursement and loan forgiveness.
• 401(k) matching.
• Lifecycle benefits to support employee well-being.
• Comprehensive benefits for physical, emotional, and financial health.