Utilization Review Specialist - Healthcare (Remote)

SimiTree Healthcare Consulting; United States; Remote; USD 55,000 - 65,000; Full time

Job summary

Join a forward-thinking company as a Utilization Review Specialist, where you'll play a critical role in enhancing performance and revenue potential for post-acute organizations. This position involves conducting pre-certifications, managing concurrent reviews, and collaborating with clients to ensure accurate billing. The ideal candidate is detail-oriented and possesses strong communication skills, with a background in behavioral healthcare and Utilization Review. You'll be part of a dynamic team that values your contributions and offers a competitive benefits package, including health insurance, retirement plans, and professional development opportunities.

Benefits

Health Insurance

Vision Insurance

Dental Insurance

Paid Time Off (PTO)

401K Retirement Plans

Holiday Pay

Life Insurance

Sick Leave

Professional Development Opportunities

Qualifications

• Strong organizational and communication skills are essential.
• Experience in Utilization Review within behavioral healthcare is required.

Responsibilities

• Perform pre-certifications and conduct concurrent reviews.
• Communicate with clients to coordinate billing census.

Skills

Organizational Skills

Communication Skills

Familiarity with ASAM Criteria

Substance Abuse Treatment Knowledge

HIPAA Guidelines Knowledge

Utilization Review Experience

EMR Experience

Insurance Approval Skills

Education

Bachelor's Degree

4 Years Experience in Utilization Review

Job description

Utilization Review Specialist

About SimiTree

:
SimiTree helps post-acute organizations raise performance levels and realize revenue potential. SimiTree offers clients a robust suite of services including financial, clinical, and operational consulting.

About the Role

:
As the Utilization Review Specialist, you will perform pre-certifications, conduct concurrent reviews, report discharges, and communicate with clients to coordinate billing census.

We are looking for an organized, detail-oriented professional who can multi-task and is willing to go the extra mile to get the job done. You'll be working on vital projects within a time-sensitive deadline.

Requirements

:

• Organized with strong communication skills.
• Familiar with ASAM criteria, substance abuse treatment, and HIPAA guidelines.
• Experience with Utilization Review within the behavioral healthcare field.
• EMR experience—ability to enter accurate notes in the system.
• Ability to work with insurance companies to gain approval for services.
• Bachelor's degree or 4 years' experience within Utilization Review.

Salary Range & Benefits

:

• $55,000 - $65,000
• The listed salary range is general and not necessarily reflective of the actual compensation. An offer will be made based on relevant experience and responsibilities. SimiTree offers a competitive package including health, vision, and dental insurance, PTO, 401K retirement plans, holiday pay, life insurance, sick leave, and professional development opportunities.