UTILIZATION REVIEW (UR) SPECIALIST

Stonington Institute; North Stonington (CT); On-site; USD 60,000 - 90,000; Full time

Job summary

Join a forward-thinking healthcare provider as a Utilization Review Specialist, where you will play a crucial role in coordinating patient care transitions and advocating for appropriate treatment levels. This position offers a supportive environment for professional growth, with opportunities for career advancement in a rewarding field. You will collaborate closely with clinical staff and insurance providers, ensuring that clients receive the best possible care. If you are a compassionate and dedicated professional looking to make a difference in substance abuse treatment, this is the perfect opportunity for you.

Benefits

Comprehensive Benefits

Career Advancement Opportunities

Competitive Compensation

Qualifications

• Master's Degree or Bachelor's in Psychology or related field preferred.
• Knowledge of UR processes and insurance plans is essential.

Responsibilities

• Coordinate with Admissions on LOC issues and insurance requests.
• Conduct concurrent reviews and advocate for appropriate care levels.

Skills

Utilization Review Processes

Insurance Knowledge

Mental Health Treatment

Chemical Dependency Treatment

Computer Skills

Education

Master's Degree

Bachelor's in Psychology

RN

Tools

UR Tracking System (Midas)

Job description

Join Our Team as a Utilization Review (UR) Specialist at Stonington Institute

We are seeking a caring, compassionate, and hardworking individual to join our team as a full-time UR Specialist. Our facility offers a supportive environment for professional growth and development.

Stonington Institute, part of Universal Health Services (UHS), a leading healthcare provider, specializes in substance abuse treatment for adults in Southeastern Connecticut, including medical detox, residential, partial hospitalization, and outpatient programs.

Responsibilities

• Coordinate with Admissions regarding LOC issues, insurance requests, and criteria questions.
• Complete initial precertification for various levels of care.
• Conduct concurrent reviews and advocate for appropriate levels of care based on clinical information.
• Collaborate with clinicians and payors to facilitate client care transitions.
• Maintain accurate records in the UR Tracking System (Midas) and monitor reports daily.
• Communicate insurance changes and denials promptly, including appeals.
• Serve as a liaison between insurance and clinical staff, providing necessary disposition information.
• Participate in monthly UR meetings.

Qualifications

Preferred: Master's Degree; Bachelor's in Psychology or related Human Service Field; RN. Knowledge of UR processes, insurance plans, mental health, and chemical dependency treatment. Computer skills are a plus.

Additional Information

We offer a challenging and rewarding work environment, career advancement opportunities, comprehensive benefits, and competitive compensation. Join us today!