Utilization Review Specialist

Parkside Hospital; Tulsa (OK); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental, and Vision

Generous Paid Time Off and Holidays

401K with generous match

Company Paid Life Insurance and Disability

Job summary

Parkside Hospital in Tulsa, OK, is seeking a Full Time Utilization Review Specialist to assess and manage insurance authorizations and compliance with regulatory standards. You will be a vital part of a mission-driven team that is focused on providing excellence in patient care.

Qualified candidates will have a Bachelor’s degree and at least two years of experience in healthcare or utilization review. Attractive benefits include medical, dental, vision, and a 401K with matching.

Qualifications

• Bachelor’s degree in related field from an accredited university required.
• 2 years minimal experience in healthcare, utilization review, and business setting.

Responsibilities

• Prepare authorization paperwork and processes requests for authorizations.
• Communicate with clinicians regarding discharge issues relevant to patient’s pay source.
• Track due dates for authorization reviews and alert clinicians.
• Maintain knowledge of managed care requirements to increase authorizations.
• Coordinate the appeal process for authorization denials.

Skills

Utilization review

Knowledge of Medicare/Medicaid

Communication with clinicians

Organizational skills

Flexibility in stressful situations

Education

Bachelor’s degree in related field

Job description

Job Details

Job Location: Parkside Hospital - Tulsa, OK 74120

Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time.

Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on society’s most vulnerable population, Parkside provides world‑class mental health services for youth and adults. For over 65 years, Parkside’s physicians, therapists, and staff have provided state‑of‑the‑art, patient‑centered care that propels families from hopeful to hope‑filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time.

We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist assesses, plans, implements and evaluates the internal processes to limit possible recoupment from third‑party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.

Responsibilities

• Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.
• Communicates with clinicians regarding discharge issues relevant to patient’s pay source. Tracks due dates for authorization reviews and alerts clinicians.
• Communicates with clinicians regarding admissions and discharges to various units.
• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.
• Coordinates/completes the appeal process for authorization denials.
• Performs audits of clinical services to ensure compliance with standards of third‑party pay sources and agency policies.
• Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.
• Maintains a good working relationship within the department and with other departments.
• Documentation meets current standards and policies.
• Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.
• Orients new staff members to the unit.
• Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed.
• Performs other duties as assigned.

Qualifications

• Bachelor’s degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
• 2 years minimal experience in health care, utilization review and business setting.

Benefits include

• Medical, Dental, and Vision.
• Generous Paid Time Off and Holidays.
• 401K and match start immediately, and includes a generous match.
• Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer!