Utilization Review Specialist

RiverValley Behavioral Health; Owensboro (KY); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Tuition reimbursement

Free CEUs

Public Service Loan Forgiveness (PSLF)

Wellness and Employee Assistance

PTO + 9 paid holidays

Job summary

RiverValley Behavioral Health is seeking an Utilization Review Support Specialist to ensure insurance coverage for treatment by obtaining pre-certifications and authorizations. The role requires presenting medical necessity through clinical documentation and collaborating across departments to support the UR process.

Responsibilities include verifying benefits, generating data for UR reports, and backing up UR staff as needed, while fostering strong teamwork within the UR program and partner

Qualifications

• Requires a high school diploma or GED with 2 years of mental health utilization review experience.
• Bachelor’s degree in psychology, social work, or sociology is preferred.
• Licensed practical nurse (KY) or registered nurse (KY) license acceptable.

Responsibilities

• Verifies insurance benefits and relays information to appropriate parties.
• Processes pre-certifications and authorizations for levels of care.
• Participates in treatment team meetings when necessary.
• Provides data and reports to UR supervisor upon request.
• Provides backup for UR staff as needed.
• Fosters collaboration among UR team and programs providing UR services.

Skills

Office skills

Public interaction

Organization

Computer basics

Education

High School diploma or GED with 2 years UR experience

Bachelor’s degree in human services-related field

KY LPN/RN license

Job description

The Utilization Review Support Specialist is responsible for assuring insurance coverage of clients for treatment, by obtaining pre-certification and authorizations for various levels of care from insurance companies (the payers). The pre-certification and authorizations of coverage are obtained by demonstrating medical necessity through the presentation of medical and clinical documentation meeting applicable criteria guidelines. Collaborate with programs and departments in coordinating the UR process.Why Join Our Team?Competitive payComprehensive health, dental, vision, and Telehealth benefitsPaid time off plus 9 paid holidaysRetirement plan optionsTuition reimbursement and free CEUsClinical supervision and professional developmentWellness and Employee Assistance ProgramsMileage reimbursement for work-related travelPublic Service Loan Forgiveness (PSLF) eligible employerEssential Functions:Verifies insurance benefits and relays that information to appropriate parties.Participates in skill enhancement activities.Participants in treatment team meetings when necessary.Provides data and reports to UR supervisor as requested.Provides backup for the UR Specialist or other UR staff as needed.Fosters collaborative working relationships among members of the UR team, programs providing UR services for, and management teams.Other duties as assigned by UR SupervisorEducation and Experience:High School/GED AND Two (2) years’ experience working in mental health utilization review (or equivalent)ORBachelor’s Degree in human services-related field (Psychology, Social Work, Sociology)ORKY LPN/RN LicenseKnowledge and Skills:Good knowledge of general office practices.Ability to deal effectively with the public.Good organizational skills.Basic computer skills preferred.