Utilization Review & Reimbursement Specialist

Socket.dev; Navarre (FL); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) with company match

FSA/HSA

Employee Assistance Program

Tuition Reimbursement

Growth Opportunities

Paid Time Off

8 paid holidays

Job summary

Socket.dev is seeking a Full Time Utilization Review Specialist to monitor service utilization and optimize reimbursement for the facility. The role is a Monday–Friday, day position, 40 hours weekly, based in Florida.

You will liaise with managed care organizations, conduct reviews for eligibility, and report on utilization and length of stay to leadership. Ideal candidates have a high school diploma or equivalent, plus clinical experience; utilization management background is preferred.

Qualifications

• High school diploma or equivalent required.
• Preferred degree in Social Work, Behavioral or Mental Health, Nursing, or related health field.
• Clinical experience required or 2+ years working with the facility population; utilization management experience preferred.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews for certification requirements and coordinate communication on reimbursement requirements.
• Monitor patient length of stay and inform clinical staff on issues that may impact LOS.
• Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
• Perform other functions and tasks as assigned.

Skills

Clinical experience

Utilization management

Communication

Education

High school diploma or equivalent

Associate/Bachelor's/Master's in Social Work Behavioral or Mental Health Nursing

Job description

Socket.dev is seeking a Full Time Utilization Review Specialist to monitor service utilization and optimize reimbursement for the facility. The role is a Monday–Friday, day position, 40 hours weekly, based in Florida.

You will liaise with managed care organizations, conduct reviews for eligibility, and report on utilization and length of stay to leadership. Ideal candidates have a high school diploma or equivalent, plus clinical experience; utilization management background is preferred.