Utilization Review Coordinator

Nrg-Mgmt-LLC; Boca Raton (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive salary

Health insurance

Vision and dental insurance

401(k) with company match

Paid time off and holidays

Continuing education opportunities

Job summary

Remedial Pro seeks a utilization review professional to monitor adherence to the facility’s utilization plan and ensure appropriate admissions and stays. You will handle initial and concurrent reviews, collaborating with insurers and healthcare partners to communicate plans of care and justify medical necessity.

The role requires experience in psychiatric/addiction care, strong confidentiality with HIPAA, and excellent communication and organizational skills.

Qualifications

• Bachelor's or Master’s degree in Behavioral/Mental Health Field or related experience preferred.
• 3–5 years of utilization review experience.
• Expertise in psychiatric and addiction disorders.
• HIPAA compliance and confidentiality experience.

Responsibilities

• Complete initial, concurrent, peer reviews and expedited appeals timely.
• Authorize treatment with insurance and managed care companies.
• Communicate plans of care to insurance case managers, facility staff, and partners.
• Collaborate with facilities to obtain clinical documentation for reviews.
• Ensure appropriate lengths of stay and resource utilization.
• Represent the company professionally per standards of conduct and protect patient privacy.

Skills

Utilization review

Psychiatric disorders

Addiction disorders

HIPAA compliance

Communication skills

Organizational skills

Time management

MS Office

Education

Bachelor's or Master's in Behavioral/Mental Health

Tools

Microsoft Office Suite

Job description

a { text-decoration: none; color: #464feb;}tr th, tr td { border: 1px solid #e6e6e6;}tr th { background-color: #f5f5f5;}Remedial Pro is a specialized medical billing company serving substance abuse treatment and behavioral health providers. Through services including benefits verification, billing and claims submission, and utilization review, we help treatment centers optimize revenue cycle management while focusing on delivering exceptional patient care. Our team is committed to accuracy, professionalism, efficiency, and outstanding client serviceJOB DESCRIPTIONThe primary goal is to monitor adherence to the facility’s utilization review plan to ensure the effective and efficient use of facility services and monitor the appropriateness of facility admissions and extended facility stays.Job Classification: Non Exempt Hourly Reports To: Senior RCM DirectorSupervisory Responsibilities: None.JOB DUTIES:Completes Initial, concurrent, peer reviews, and expedited appeals in a timely manner to ensure continuous coverage.responsible for all aspects of the authorization of treatment via insurance and managed care companies.Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.Collaborate with facilities in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources.Represents the company in a positive manner per the Professional Standards of ConductProtects the confidentiality of patients and the privacy of staffprovides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.Uses a computer to type correspondence, reports and other items as requested,Experience in the Mental Health/Addiction space, May be a fully licensed SUDC, CAC,LADC, LCSW, CMHC or RNAdditional duties as assigned.MINIMUM QUALIFICATIONSBachelor’s or Master’s degree in Behavioral/Mental Health Field (or related experience) preferredA minimum of 3-5 years experience doing utilization review is required preferredExpertise in psychiatric and addiction disordersExperience interacting effectively with co-workers as well as clients.Experience maintaining confidentiality in accordance with HIPAA and company policy requirements.Required Skills/Abilities:Excellent verbal and written communication skills.Excellent organizational skills and attention to detail.Excellent time management skills with a proven ability to meet deadlines.Proficient with Microsoft Office Suite or related software.PHYSICAL REQUIREMENTSProlonged periods sitting at a desk and working on a computer.Remote PositionBenefits:• Competitive salary• Health, dental, and vision insurance• 401(k) with company match• Paid time off and holidays• Continuing education and professional development opportunities