Utilization Review Specialist: Drive Care Authorizations

Oaks Integrated Care; Trenton (NJ); On-site; USD 47,000 - 63,000; Full time

Benefits offered by this job

Supplemental income

Paid time off

Career growth

FISH! philosophy team

Job summary

Oaks Integrated Care in Trenton, NJ is seeking a dedicated Utilization Review Specialist to join our office-based team. The role focuses on securing prior authorizations, documenting medical necessity, and coordinating with payers to ensure timely care.

The ideal candidate has strong organizational and communication skills, experience with insurance/managed care processes, and proficiency in EHR systems. We offer growth opportunities and a collaborative environment.

Qualifications

• Bachelor's degree required in psychology, human services, nursing, healthcare or related field.
• Master's degree preferred in Behavioral Health/Healthcare or related field; OR LPN/RN.
• Minimum 2 years of relevant experience in behavioral health or healthcare setting.
• Experience with prior authorizations and insurance claim processes is a plus.

Responsibilities

• Requesting and obtaining prior authorizations for treatment services from Medicaid, MCOs, EAP, etc.
• Facilitating prior authorization requests and concurrent reviews with payer sources.
• Managing and tracking prior authorization approvals to avoid gaps in care.
• Coordinating with program leadership to ensure clinical documentation is complete for authorizations.
• Engaging in Continued Stay Reviews to justify continuation of care.
• Verifying insurance coverage and ensuring payment sources for all clients.
• Other duties as assigned.

Skills

Time management

Communication skills

Interpersonal skills

Written and verbal communication

Education

Bachelor's degree in psychology/healthcare

Master's degree preferred

LPN or RN

Tools

Microsoft Office (Excel)

Electronic Health Records

NJSAMs

Navinet

Job description

Oaks Integrated Care in Trenton, NJ is seeking a dedicated Utilization Review Specialist to join our office-based team. The role focuses on securing prior authorizations, documenting medical necessity, and coordinating with payers to ensure timely care.

The ideal candidate has strong organizational and communication skills, experience with insurance/managed care processes, and proficiency in EHR systems. We offer growth opportunities and a collaborative environment.