Behavioral Health Utilization Review Specialist

Memorial Physician Practices; Fort Worth, Northern (TX, KY); Hybrid; USD 60,000 - 70,000; Full time

Benefits offered by this job

Comprehensive Benefits

PTO & Disability

Tuition assistance

401(k) with company match

Wellness programs

Job summary

Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations, accuracy in denials and certifications, and effective communication with physicians and care teams.

You will apply clinical criteria, coordinate with managed care organizations, complete pre- and post-certifications, and help the treatment team understand coverage.

Qualifications

• Bachelor's degree required
• Master's degree preferred
• Experience in utilization review desirable

Responsibilities

• Apply clinical criteria to determine authorization decisions
• Coordinate pre- and post-certifications for inpatient and outpatient services
• Report denials and authorizations to appropriate stakeholders
• Communicate with interdisciplinary team for updates on authorizations
• Participate in treatment teams to share coverage information
• Collaborate with DON to ensure documentation requirements
• Interface with managed care and external reviews
• Schedule peer-to-peer reviews with physicians
• Ensure timely and thorough appeals

Job description

Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations, accuracy in denials and certifications, and effective communication with physicians and care teams.

You will apply clinical criteria, coordinate with managed care organizations, complete pre- and post-certifications, and help the treatment team understand coverage.