Behavioral Health Utilization Review Specialist

Gosnold; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Blue Cross & Blue Shield health and/or

Vision insurance

Flexible spending accounts (Medical/De

Paid vacation, sick and holidays

403b retirement savings with employer1

Personal financial management services

Life and supplemental life insurance

Critical illness and accident coverage

Employee Assistance Program

Pet insurance

Tuition assistance

Job summary

Gosnold is seeking an Utilization Review Specialist to perform pre-certification and concurrent reviews, working closely with clinical teams to coordinate care and ensure patient coverage. The role requires strong communication with Patient Financial Services and meticulous documentation of UR data.

Ideal candidates will have a relevant Bachelor's degree and at least two years of clinical experience in health services, with knowledge of levels of care and medical criteria.

Qualifications

• Bachelor's degree in nursing, social work, psychology, mental health or addiction required.
• Experience in utilization review and/or clinical services in an intensive treatment setting preferred; at least 2 years of clinical experience.
• Knowledge of clinical criteria for various levels of care.

Responsibilities

• Perform utilization review of pre-certification and concurrent clinical utilization reviews.
• Communicate daily with Patient Financial Services to ensure patient coverage.
• Collaborate with interdisciplinary treatment teams to coordinate care and authorizations.
• Consult with clinical staff to update intervention strategies and continued care authorizations.
• Document authorizations and UR results in the computer system and report progress to teams.
• Educate treatment teams about member benefits and aid in arranging aftercare.

Skills

Communication

Interpersonal skills

Organizational skills

Computer literacy

Education

Bachelor's degree in nursing, social work, psychology, mental health or addiction

Job description

Gosnold is seeking an Utilization Review Specialist to perform pre-certification and concurrent reviews, working closely with clinical teams to coordinate care and ensure patient coverage. The role requires strong communication with Patient Financial Services and meticulous documentation of UR data.

Ideal candidates will have a relevant Bachelor's degree and at least two years of clinical experience in health services, with knowledge of levels of care and medical criteria.