Utilization Review Specialist

Samhsa; New York (NY); On-site; USD 60,000 - 75,000; Full time

Job summary

Samhsa in New York seeks an Utilization Review Specialist to bridge inpatient and ambulatory services with managed care organizations. You will manage authorizations for all care levels and review medical necessity while closely coordinating with our inpatient and outpatient teams.

The role requires at least one year in healthcare or managed care and a Bachelor’s degree in Human or Health Services (preferred). This position is based at our New York facility.

Qualifications

• One year of experience in healthcare or managed care settings.
• Undergraduate/Bachelor Degree in Human or Health Services (preferred).

Responsibilities

• Liaison between hospital inpatient and ambulatory services and managed care organizations.
• Obtain authorization for all levels of care and perform medical necessity reviews.
• Monitor patient benefits and coordinate with hospital departments.

Skills

Healthcare experience

Managed Care knowledge

Education

Bachelor's degree in Human or Health Services

Job description

The Utilization Review Specialist's primary role is the liaison between the hospitals inpatient and ambulatory services and the managed care organizations. The UR specialist is responsible for a wide range of administrative responsibilities including obtaining authorization for all levels of care, medical necessity review, monitoring of patients benefits and is knowledgeable of SJMC contractual agreements. The UR specialist works closely with numerous depts. within the hospital, including the inpatient and outpatient treatment teams, Evaluation and Referral, Benefits and Patient Accounts.

One year experience in Healthcare and/or Managed Care Setting required.

Undergraduate/Bachelor Degree (required) in Human or Health Services (preferred)