Utilization Review Specialist - (40 hours 8a-4p) - Remote

Gosnold; Wareham (MA); Remote; USD 60,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Flexible spending accounts

Paid vacation

Sick time

Holiday time

403b or 401k match

Life insurance

Critical illness insurance

Accident insurance

Employee Assistance Program

Tuition assistance

Job summary

Gosnold in Wareham, MA seeks a Utilization Review Specialist for a remote, full-time role (40 hours, 8a-4p). The position focuses on pre-certification and concurrent clinical utilization reviews with insurers, ensuring patient coverage and collaboration with Patient Financial Services.

Candidates should have a bachelor’s degree in nursing, social work, psychology, mental health or addiction, plus two years of clinical experience and knowledge of clinical criteria for levels of care.

Qualifications

• Bachelor’s degree in nursing, social work, psychology, mental health or addiction is required.
• Two years of clinical experience in utilization review or delivery of health services is preferred.
• Knowledge of clinical criteria for levels of care.
• Computer literacy and ability to learn behavioral health software programs; good communication and interpersonal skills.

Responsibilities

• Review pre-certification and concurrent utilization reviews with insurers.
• Coordinate recommendations with clinical staff for intervention strategies and authorizations.
• Provide technical assistance to staff on care coordination activities.
• Prepare and present cases for physician reviews as needed.
• Document authorizations and UR results in the system; report progress to treatment teams.

Skills

Computer literacy

Communication skills

Interpersonal skills

Organizational skills

Education

Bachelor’s degree in nursing, social work, psychology, mental health or addiction

Tools

Behavioral health software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Utilization Review Specialist - (40 hours 8a-4p) - Remote

ATS Wareham Office Staff Wareham, MA, US

Salary Range: $60,000.00 To $65,000.00 Annually

*Candidates must live in Massachusetts

SUMMARY:

The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification requirements of each patient’s insurance plan. This position requires daily communication with Patient Financial Services to ensure that every patient is covered for their stay. The Utilization Review Specialist must have experience working on interdisciplinary treatment teams.

ESSENTIAL JOB FUNCTIONS/DUTIES/RESPONSIBILITIES:

• Working knowledge of managed care principles with preference for experience in behavioral health.
• Consult with clinical staff to coordinate recommendations for intervention strategies and authorizations for continued care.
• Provide technical assistance to staff with care coordination activities as needed.
• Prepare and present cases for physician when necessary for doctor-to-doctor reviews.
• Document and record authorizations and UR results in the computer system. Record and report to treatment teams the progress and expectations for the next UR review.
• Daily communication and education with the treatment teams about the member’s insurance benefits and aid them in coordinating the most comprehensive after care for the patient.
• Provide information to managed care providers about alternative levels of care within the Gosnold system and accurately promotes these services.
• Perform all other duties as assigned.

SUPERVISORY RESPONSIBILITIES :N/A

MINIMUM KNOWLEDGE, Experience, AND SKILLS REQUIRED:

The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform the job.

• Education: Bachelor’sdegree in nursing, social work, psychology, mental health or addiction required.
• Experience: Experience in performing utilization review and/or providing clinical services in an intensive treatment setting is preferred and at least (two) 2 years of clinical experience in delivery of health services. Knowledge of clinical criteria required for various levels of care.
• Skills:Computer literacy and ability to learn and use behavioral health software programs. Good communication, interpersonal, and organizational skills.

Certificates, Licenses, and Registrations: N/A

BENEFITS (based on full-time employment):

• Blue Cross & Blue Shield health and dental insurance
• Vision insurance
• Medical and dependent care flexible spending accounts
• Generous paid vacation, sick,and holiday time
• 403b retirement savings plan with employer match
• Life and supplemental life insurance
• Critical illness and accident insurance
• Employee Assistance Program
• Tuition assistance

Gosnold is an Equal Opportunity Employer.