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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies.
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Utilization Review Specialist/Behavioral Health Substance Abuse. The Utilization Review Specialist provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
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Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator). Prior Utilization Review experience in a Substance abuse environment is mandatory.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Utilization Review Specialist performs a variety of functions which includes but not limited to, navigating electronic medical records and advocating for the patient; Communicating with insurance carriers via phone/ fax as needed.
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Utilization Review Specialist. Incumbents review client health records to ensure proper utilization of treatment resources. Please click here to review the Samples of Duties.
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As the Surveillance and Utilization Review Supervisor within the Quality Assurance section, you will be responsible for leading a team of professionals in support of Alaska's fraud, waste, and abuse efforts for the Medicaid Program.
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As an Utilization Review Specialist you will maintain contact with provider liaisons for each child placed in a congregate care setting to complete reviews on how well the child is doing and monitor individual treatment goals, progress towards goals for a successful placement in a less restrictive environment.
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Amity Foundation an internationally acclaimed teaching, and therapeutic community is seeking compassionate and enthusiastic individuals with a desire to teach, learn and join our community as a Utilization Review Specialist at our campus in Tucson, AZ. With this groundbreaking opportunity not only will you be working with our home offices, but you will also be enhancing your training and experience in the field and supporting the growth of our community.
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As a Utilization Review Specialist, you will accurately and timely complete utilization review activities. Requirements: Bachelor’s degree or current clinical license required in lieu of degree CPR and CPI Certification within 30 days of employment Experience: Previous utilization review experience in a psychiatric healthcare facility preferred Education and experience in the field(s) of: Social Work, Psychology, Psychiatric Nursing, Marriage and Family and Child Counseling, Chemical Dependency Counseling, Registered Nursing or a closely related science field.
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Samples of DutiesKnowledge, Skills and AbilitiesMinimum QualificationsExperience: Two (2) years of full-time, paid, post-licensure work experience providing direct behavioral health care services as a Licensed Clinical Social Worker, Licensed Professional Clinical Counselor, Licensed Marriage and Family Therapist, or Registered Nurse.
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RequirementsTo be considered for the Utilization Review Specialist position, you will need:Master's degree from an accredited college or university in social work, mental health, nursing, or related degree Required.
$60,000 - $70,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are unable to provide any additional information to support the need for medically necessary hospital care.
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Job Summary:The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.
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The Utilization Review Specialist will examine medical and behavioral health insurance benefits to ensure proper coverage, address lapses in coverage, manage authorization process, billing process, decipher complicated insurance laws and policies including Medicare, Medicaid, Behavioral Health Coverage, and Commercial Health Insurance Coverage.
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The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records for the patient population and HackensackUMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care, as outlined in the responsibilities belo.
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Title: utilization review specialist
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