Utilization Review Specialist for Mental Health Appeals

Raleigh Oaks Behavioral Health; Garner (NC); On-site; USD 60,000 - 90,000; Full time

Job summary

Raleigh Oaks Behavioral Health is seeking an Utilization Specialist to review admissions, concurrent stays, and discharge planning according to established criteria. You will communicate with insurers and physicians, pursue appeals of denials, and coordinate with the admissions team on pre-certifications and benefits verification.

The role requires a nursing or related health degree and current licensure as RN or LPN, with at least two years of direct clinical psychiatric experience. EOE.

Qualifications

• Direct clinical experience in a psychiatric/mental health setting is required.
• Ability to communicate with physicians and providers about utilization issues.
• Experience with the appeals process and coordination of denials.

Responsibilities

• Review admissions, concurrent stays, and discharge planning per criteria.
• Communicate with insurers and HMOs for approval of inpatient days.
• Coordinate and monitor utilization review activities and prepare reports.

Skills

Clinical experience in psychiatric/med

Interdisciplinary communication

Appeals processing

Education

Bachelor's degree in nursing or related health field

RN/LPN licensure as required by state

Job description

Raleigh Oaks Behavioral Health is seeking an Utilization Specialist to review admissions, concurrent stays, and discharge planning according to established criteria. You will communicate with insurers and physicians, pursue appeals of denials, and coordinate with the admissions team on pre-certifications and benefits verification.

The role requires a nursing or related health degree and current licensure as RN or LPN, with at least two years of direct clinical psychiatric experience. EOE.