Healthcare Utilization & Authorization Specialist

Oaks Integrated Care Inc.; Trenton (NJ); Hybrid; USD 47,000 - 63,000; Full time

Benefits offered by this job

Supplemental income

Paid time off

Career growth

FISH! philosophy

Team environment

Job summary

Oaks Integrated Care Inc. in Trenton, New Jersey seeks a dedicated Utilization Review Specialist to manage prior authorizations, pre-certifications, and appeals for our behavioral health programs.

You will verify insurance coverage, coordinate with program leadership, maintain clinical documentation for payers, and support timely approvals to prevent gaps in care. A Bachelor's degree or equivalent healthcare experience, plus 2+ years in behavioral health, is preferred.

Qualifications

• Bachelor's Degree required in psychology/human services/nursing/healthcare or related field; Master's Degree preferred; OR LPN or RN

Responsibilities

• Requesting and obtaining prior authorizations for treatment services from Medicaid, MCOs, NJSAMS, commercial insurance, EAP, etc.
• Facilitating prior authorization requests and concurrent reviews with all payer sources
• Managing and tracking prior authorization approvals and requests to ensure no gaps in care
• Coordinating with program leadership to ensure clinical documentation is timely and sufficient for prior authorization
• Engaging in Continued Stay Reviews to determine continuation of care
• Coordinating with Accounts Receivable to manage authorizations and receipts
• Verifying insurance coverage and ensuring payment sources for services
• Facilitating presumptive eligibility for eligible clients
• All other duties as assigned
• Supplemental income
• Generous paid time off benefits
• Opportunity for personal and career growth
• Team oriented environment – we practice the FISH! Philosophy

Skills

prior authorizations

insurance verification

EHR systems

Microsoft Office

Education

Bachelor's degree in psychology/healthcare or related field

LPN or RN

Tools

Excel

Navinet

NJSAMs

EHR systems

Job description

Oaks Integrated Care Inc. in Trenton, New Jersey seeks a dedicated Utilization Review Specialist to manage prior authorizations, pre-certifications, and appeals for our behavioral health programs.

You will verify insurance coverage, coordinate with program leadership, maintain clinical documentation for payers, and support timely approvals to prevent gaps in care. A Bachelor's degree or equivalent healthcare experience, plus 2+ years in behavioral health, is preferred.