Utilization Review Specialist — Mental Health

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

Benefits offered by this job

Competitive salary

Comprehensive benefits package

Veteran-friendly workplace

Job summary

Raleigh Oaks Behavioral Health in Garner, NC is seeking an Utilization Review Specialist to review admissions, concurrent stays, and discharge planning using approved criteria. You will communicate with insurers and physicians to obtain authorizations and support clinical decisions.

The role requires nursing or related health degree, 2+ years psychiatric experience, and current LPN/RN licensure. You will document findings, educate staff, and support reimbursement processes while adhering to

Qualifications

• Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field.
• Two or more years of direct clinical experience in a psychiatric/mental health setting.
• Current licensure as an LPN or RN or current clinical professional license or certification, as required.
• Effective communication with physicians, staff, and payers.

Responsibilities

• Perform admission, concurrent, continued stay, and retrospective reviews using established criteria.
• Communicate with insurers and HMOs to obtain initial or additional inpatient days approvals.
• Support discharge planning and coordination of care with clinicians and staff.
• Assist admissions with pre-certifications and benefit verification with managed care organizations.
• Maintain documentation and reporting for utilization management and quality review.

Skills

Communication with providers

Documentation & charting

Clinical knowledge in psychiatry

Medical terminology

Education

Bachelor's degree in nursing or related health field

LPN or RN licensure

Tools

Electronic Health Records (EHR)

Job description

Raleigh Oaks Behavioral Health in Garner, NC is seeking an Utilization Review Specialist to review admissions, concurrent stays, and discharge planning using approved criteria. You will communicate with insurers and physicians to obtain authorizations and support clinical decisions.

The role requires nursing or related health degree, 2+ years psychiatric experience, and current LPN/RN licensure. You will document findings, educate staff, and support reimbursement processes while adhering to