Utilization Review Representative

Utilization Review Representative

We are currently seeking a full time Utilization Review Representative to join our team.

Job Summary:

This position is responsible for taking the data provided to their department and using it to communicate with medical and counseling staff to ensure services are provided at the appropriate level of care in a timely manner consistent with the patient’s conditions and in compliance with governmental and accrediting agencies.  Day-to-day responsibilities may vary.

Job Duties and Responsibilities:

Core duties and responsibilities include but are not limited to the following. Other duties may be assigned as necessary.

  • Proven experience in conceptualizing a case, and creating a clinical impression to present to all managed care representatives.
  • Establish and maintain positive effective communication with insurance case
  • Read and understand patients case notes and be able to assign appropriate diagnosis codes.
  • Call in intakes and/or peer to peers, and get the patients appropriate level of care authorized by the case managers.
  • Obtain and communicate LOC and authorizations and properly enter into the system.
  • Detailed system documentation of accounts.
  • Communicating with other departments to obtain or provide needed information on an account.
  • Special Projects as needed.

Required Education and Experience:

  • Five or more years experience working in a psychiatric or chemical dependency setting, with five years of utilization review experience.
  • Bachelors Degree requires, Masters Degree preferred.
  • Preferred credential types: PhD, PsyD, MD, Nurse Practitioner, Licensed Mental Health Counselor, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, or Registered Nurse with Psychiatric training and experience.

Required Knowledge, Skills, and Abilities:

  • Knowledge of CPT, ICD 9 & ICD 10 coding, medical terminology, and EMR Systems.
  • Proficiency in Microsoft Office Applications including Excel, PowerPoint, and Word.
  • Knowledge of HIPAA regulations and guidelines.
  • Knowledge of managed care and reimbursement principles.
  • Collaboration and negotiation skills.
  • Must be organized, detail oriented, and have the ability to multitask.
  • Excellent verbal and written communication skills.
  • Critical thinking and problem solving skills.
  • Must be able to work in a team environment.
  • Behavioral health knowledge is a plus.

Compensation and Benefits:

  • Competitive market-based salary, salary commensurate with experience.
  • Benefits package available.

How To Apply:

Email resume with salary history and a cover letter to be considered.