Utilization Review Specialist - (40 hours 8a-4p) - Remote
Wareham, Massachusetts
Posted Nov 3
- License
- Certificates, Licenses, and Registrations: N/A
- Term
- Permanent
Do you qualify?
- License
- Certificates, Licenses, and Registrations: N/A
- Education
- Bachelor’s degree in nursing, social work, psychology, mental health or addiction required.
- Also asks
- Knowledge of clinical criteria required for various levels of care.
- Also asks
- Computer literacy and ability to learn and use behavioral health software programs. Good communication, interpersonal, and organizational skills.
Preferred
- Experience
- Experience in performing utilization review and/or providing clinical services in an intensive treatment setting is preferred and at least (two) 2 years of clinical experience in delivery of health services.
What it pays
Benefits
- 403(b) matching
- Paid holidays
- Health insurance
- Dental insurance
- Flexible spending account
- Tuition reimbursement
- 403(b)
- Life insurance
The workplace
Your fit
Questions to ask
- Can you walk me through differentials?
- What should I expect for shifts, weekly hours, weekend, holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?
On your path
Case Management is a specialty you move into. Bedside years first. That experience is what gets you in.
Original listing
Posted on Gosnold’s careers page.
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Summary
The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification requirements of each patient’s insurance plan. This position requires daily communication with Patient Financial Services to ensure that every patient is covered for their stay. The Utilization Review Specialist must have experience working on interdisciplinary treatment teams.
Essential job functions/duties/
Responsibilities
Working knowledge of managed care principles with preference for experience in behavioral health. Consult with clinical staff to coordinate recommendations for intervention strategies and authorizations for continued care. Provide technical assistance to staff with care coordination activities as needed.
Prepare and present cases for physician when necessary for doctor-to-doctor reviews. Document and record authorizations and UR results in the computer system. Record and report to treatment teams the progress and expectations for the next UR review.
Daily communication and education with the treatment teams about the member’s insurance benefits and aid them in coordinating the most comprehensive after care for the patient. Provide information to managed care providers about alternative levels of care within the Gosnold system and accurately promotes these services. Perform all other duties as assigned.
Supervisory
Responsibilities
N/A
MINIMUM KNOWLEDGE, Experience, AND SKILLS REQUIRED
The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform the job.
Education
Bachelor’s degree in nursing, social work, psychology, mental health or addiction required.
Experience
Experience in performing utilization review and/or providing clinical services in an intensive treatment setting is preferred and at least (two) 2 years of clinical experience in delivery of health services. Knowledge of clinical criteria required for various levels of care.
Skills
Computer literacy and ability to learn and use behavioral health software programs. Good communication, interpersonal, and organizational skills.
Certificates, Licenses, and Registrations: N/A
BENEFITS (based on full-time employment)
- Blue Cross & Blue Shield health and dental insurance
- Vision insurance
- Medical and dependent care flexible spending accounts
- Generous paid vacation, sick, and holiday time
- 403b retirement savings plan with employer match
- Personal financial management services
- Life and supplemental life insurance
- Critical illness and accident insurance
- Employee Assistance Program
- Pet insurance
- Tuition assistance
Gosnold is an Equal Opportunity Employer.