Utilization Review Specialist

Tully Hill Treatment & Recovery; Town of Tully (NY); On-site; USD 37,195 - 52,348; Full time

Benefits offered by this job

Health insurance

401(k) plan

Vacation, sick and personal time

Paid holidays

Company-paid short-term disability insurance

Voluntary dental insurance

Voluntary life insurance

Job summary

A health care provider in New York is seeking a Utilization Review Specialist. The role involves providing clinical information to insurance companies, reviewing medical records, and conducting admission processes. Candidates should hold an RN, LPN licensure or similar certification and possess strong communication skills. This full-time position offers competitive hourly pay and a comprehensive benefits package in a supportive environment focused on helping individuals with substance use disorders.

Qualifications

• Experience in utilization review or managed care is preferred.
• Comply with CARF standards and NYS OASAS regulations.

Responsibilities

• Provide clinical and medical information for insurance coverage.
• Review medical records for necessary information completeness.
• Conduct pre-admission and admission processes.

Skills

Ability to work in a fast-paced environment

Strong written and verbal communication skills

Competency in electronic medical records

Knowledge of substance use disorder

Education

Current RN, LPN licensure or other NYS QHP certification

Job description

Join to apply for the Utilization Review Specialist role at Tully Hill Treatment & Recovery

Do you have a passion for helping others? Tully Hill Treatment and Recovery is dedicated to the belief that substance use disorder is a disease – chronic, progressive and above all, treatable. Join the multidisciplinary team of professionals committed to helping patients and families live sober, productive, happy lives, free of addiction and its aftermath. We provide challenging and rewarding work for those with the skills and aptitude to work with individuals in their most vulnerable condition.

Responsibilities

• Provide clinical and medical information to insurance companies and third‑party payers to justify initial admission and continued stay coverage and prevent denial of payment.
• Research and communicate insurance companies’ treatment requirements to the treatment team.
• Facilitate appeals of patient claims and coordinate with the multidisciplinary team to ensure appropriate level of care via treatment and care documentation that meets payers’ criteria.
• Review medical records for completeness of necessary clinical, nursing, and medical information and communicate deficiencies to the treatment team.
• Assist in conducting pre‑admission and admission processes by interviewing, screening, evaluating potential patients, obtaining treatment authorization, communicating patient financial responsibilities, and documenting pertinent information into the electronic medical record.

Qualifications

• Ability to work in a fast‑paced environment as part of a multidiciplinary team.
• Strong written and verbal communication skills.
• Competency in an electronic medical record and good computer skills.
• Current RN, LPN licensure or other NYS QHP certification required.
• Ensure quality, timeliness, and accuracy of documentation to ensure compliance with CARF standards, NYS OASAS regulations, other applicable State and Federal regulations, referral partners, and insurance contract and reimbursement requirements.
• Demonstrable knowledge of substance use disorder and 12‑step philosophy and commercial health insurance preferred.
• Previous utilization review / managed care work experience a plus.

Senior level: Mid‑Senior level

Employment type: Full‑time

Job function: Other

Industries: Hospitals and Health Care

Location: Syracuse, NY – with a beautiful well maintained property on 33 acres in the Tully Valley, just 15‑20 minutes south of Syracuse.

Salary Range – $27.00–$38.00 per hour

Benefits

• Health insurance
• 401(k) plan
• Vacation, sick and personal time
• Paid holidays
• Company‑paid short‑term disability insurance
• Voluntary dental insurance
• Voluntary additional disability insurance
• Voluntary life insurance

Tully Hill Treatment and Recovery is a 501(c)(3) not‑for‑profit corporation, mission driven and following a business model. Pay rate is commensurate with experience and education/credentials. Comprehensive benefits package included.

Salary range provided in accordance with NYS law, based on Tully Hill’s good faith belief at the time of posting. Factors considered include the position and associated responsibilities, market and business considerations, candidate’s education/training, credentials, and work experience.