The Utilization Review (UR) Specialist is responsible for contacting external case managers and managed care organizations for pre-authorization and concurrent reviews throughout the duration of a consumers stay. The Specialist assists the treatment planning team in understanding insurance requirements, and completes UR audits for billing compliance.
Qualifications & Skills
Ability to understand and apply federal, state and local regulations and laws governing quality assurance and utilization review
Knowledge of methods and procedures of admissions, discharges and consumer care in mental health programs
Effective written and verbal communication skills
Ability to use good judgment in making critical decisions about the necessity of treatment
Required Licenses or Experience
Masters degree in psychology, counseling, social work, psychiatric nursing (RN), or related behavioral health field
NJ RN, LCSW or LPC strongly preferred
Minimum two (2) years related experience in utilization review
Minimum two (2) years experience in the mental health field
Valid Drivers license in state of residence and a safe driving record* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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