This position is Full Time and hours may vary. This position must demonstrate exceptional customer service skills with the ability to effectively communicate with internal and external customers. This position will assess clients to determine the appropriate Level of Care and will obtain authorization for a caseload of patients. The Utilization Review Specialist is responsible for organizing and coordinating Utilization Review activities within the facility in accordance with standards of State and Federal regulations, accreditation standards, and payor guidelines.
- Completes Initial, concurrent, Peer Reviews, Expedited Appeal Reviews, and retrospective reviews in a timely manner to ensure continuous coverage.
- Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
- Collaborate with Clinicians daily in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources.
- Prepare and submit Appeals
- Ability to multi-task, demonstrate flexibility, and prioritize in a time-sensitive and often demanding environment
- Organized and detail-oriented
- Ability to manage time effectively
- Ability to work with minimal supervision
- Proficient in Excel, Word, and electronic charting.
- Engages in appropriate written and verbal communication with families, insurance companies, and other professionals.
- A minimum of one-year experience working with the Utilization Review process is preferred.
Integra Connect, LLC provides a comprehensive benefits plan.
- Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
- 401k with employer match
- Paid Time Off
- Paid Holidays and Floating Holiday
Equal Opportunity Employer
|Job Category||Revenue Management|