[Hiring] Behavioral Health Utilization Review Specialist @Assembly Health

Role Description

This is a full-time, non-exempt position reporting to a UR Team Lead. The salary for this role starts at 60k.

• Evaluate patient medical records to determine the necessity and appropriateness of services provided.
• Analyze utilization data to identify trends, patterns, and opportunities for improvement.
• Provide recommendations to improve efficiency and effectiveness of care delivery.
• Manage utilization review schedule with providers and carriers.
• Communicate with behavioral health providers to obtain necessary information and clarify clinical details.
• Communicate with insurance companies to resolve coverage issues and denials.
• Collaborate with medical and administrative staff to ensure compliance with established protocols and guidelines.
• Ensure that patient care meets regulatory requirements, accreditation standards, and payer requirements.
• Conduct reviews in a timely manner for each patient.
• Stay updated on changes in regulations, standards, and guidelines affecting utilization review practices.
• Obtain prior authorizations for services as required by insurance companies and other payers.
• Monitor authorization periods and ensure timely renewals.
• Maximize authorizations from insurance providers for all levels of care.
• Maintain accurate and detailed records of reviews, decisions, and communications.
• Effectively report and resolve any issues that affect authorizations.
• Prepare and submit required reports to management, payers, and regulatory agencies.
• Review and appeal denied claims or services as necessary, providing appropriate clinical information and documentation.
• Attend UR meetings to discuss activities/needs of UR department.
• Execute additional duties as assigned, demonstrating diligence and meticulous attention to detail.

Qualifications

• Experience in healthcare, behavioral health (mental health, chemical dependency, or psychiatric nursing) preferred.
• Minimum of one year experience in utilization review.
• Comfortable working with common billing and EMR/EHR software.
• Familiar with both inpatient and outpatient levels of care (MH and SUD).
• Knowledgeable of standard medical necessity criteria.
• Adherence to strict confidentiality standards to safeguard patient care information and protect patient rights.
• Solid command of Microsoft Office applications, Google Suite, Adobe Acrobat, and other technologies.
• Strong attention to detail and accuracy in data entry and financial records maintenance.
• Capability to manage multiple tasks and prioritize workload to meet deadlines.
• Keen attention to detail, dependable, accountable, quick learner.
• Exceptional interpersonal skills, organized, positive attitude, excellent verbal and written skills, excellent organizational skills, self-motivated and driven.
• Complies with all performance measuring regarding pre-certification, concurrent reviews, and appeals.
• Ability to function well in a fast-paced and at times stressful environment.
• Prolonged periods of sitting at a desk and working at a computer. Ability to lift and carry items weighing up to 10 pounds at times.

Benefits

Compensation for this role is based on a variety of factors, including but not limited to, skills, experience, qualifications, location, and applicable employment laws. The expected salary range for this position reflects these considerations and may vary accordingly. In addition to base pay, eligible employees may have the opportunity to participate in company bonus programs. We also offer a comprehensive benefits package, including medical, dental, vision, 401(k), paid time off, and more.