Utilization Review Specialist

Praesum Healthcare; West Palm Beach (FL); Vor Ort; USD 55.000 - 75.000; Vollzeit

Benefits dieser Stelle

Medical, dental, vision, and STD insurance options

401(k) with company match

Accrued paid time off (PTO)

Education reimbursement

Career advancement opportunities

Zusammenfassung

Evolve Treatment Centers in West Palm Beach, Florida, is seeking a full-time Utilization Review Specialist. This role involves initiating pre-certification authorizations, communicating with facilities, and maintaining patient census. Candidates should have a High School Diploma and 3–5 years of utilization review experience.

Benefits include medical, dental, and vision insurance, a 401(k) with company match, accrued paid time off, and educational reimbursement.

Qualifikationen

• 3–5 years of utilization review experience required.
• Computer literate with proficiency in Microsoft Office applications.
• Strong communication skills to interact with facilities and patients.

Aufgaben

• Initiate pre‑certification and continued stay authorizations based on ASAM criteria.
• Communicate directly with facilities regarding patients’ needs.
• Maintain daily census and schedule all new admissions.

Kenntnisse

Utilization review experience

Proficiency in Microsoft Office

Communication skills

Ausbildung

High School Diploma

Jobbeschreibung

Praesum Healthcare, founded in 2003, provides administrative services for behavioral health facilities in the Northeast, mid‑Atlantic, and Southeast regions. Praesum supports inpatient psychiatric, substance abuse detoxification, SUD and mental health outpatient clinics.

Position Title: Utilization Review Specialist

Responsibilities

• Initiate pre‑certification and continued stay authorizations based on ASAM criteria
• Communicate directly with facilities regarding patients’ needs and symptomology
• Maintain daily census and schedule all new admissions and concurrent reviews
• Enter authorizations and demographic information into the EHR for billing purposes
• Complete “peer‑to‑peer” reviews and schedule “doctor‑to‑doctor” reviews when needed
• Confirm insurance coverage for each patient
• Organize weekend census of all detox and residential patients for our inpatient facilities
• Collect appropriate clinical data required for precertification

Requirements

• High School Diploma
• 3–5 years of utilization review experience
• Computer literate with proficiency in Microsoft Office applications

Schedule

• Full‑time, Friday – Monday (weekends), including potential for bonus
• 8:30 am to 5:00 pm

Benefits

• Medical, dental, vision, and STD insurance options
• Medical FSA and dependent‑care account
• 401(k) with company match up to 5%
• Accrued paid time off (PTO)
• Education reimbursement
• Career advancement opportunities

This job does NOT sponsor visas and we are unable to consider out‑of‑country applicants.