Utilization Review Specialist Behavioral Health | Remote
Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks
Shift: Days
Pay Rate Type: Hourly
Location: Remote
Listed is the base hiring salary range offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary range listed is just one component of the total rewards/compensation package offered to candidates.
Min = $33.74
Mid = $42.17
Max = $50.61
Summary:
The Utilization Review (UR) Specialist is responsible for engaging patients’ insurances and attaining pre-authorizations and re-authorizations as needed for the Intensive Outpatient Program (IOP) and continued authorizations for inpatient behavioral health services. This includes conducting thorough reviews of patient records and communicating with therapists, physicians, and treatment team members. The UR Specialist collaborates with medical professionals to gather relevant patient information and documentation, analyze medical data, and adhere to established guidelines and regulations. The role involves developing and implementing utilization management protocols, for review processes, and addressing discrepancies in patient care plans. The UR Specialist maintains accurate logs of patients covered and uncovered days and works closely with treatment team on discharge planning.
Responsibilities:
Conduct comprehensive reviews of patient medical records to determine the necessity and appropriateness of proposed medical services.
Collaborate with healthcare providers to gather information and clarify treatment plans to ensure compliance with established guidelines.
Analyze data related to patient care to identify trends and recommend improvements in utilization practices.
Prepare detailed reports on utilization, review findings and present them to management for decision-making purposes.
Coordinate with insurance companies to verify coverage and obtain prior authorizations for necessary treatments. Communication determinations effectively, providing clear, evidence-based rationales for approval or denial decisions
Ensure compliance with state and federal regulations regarding healthcare services and utilization reviews.
Participate in multidisciplinary team meetings to discuss patient care and the effectiveness of treatment plans.
Stay updated on industry trends and changes in healthcare policies that may impact utilization review practices.
Credentials:
Essential:
* BASIC LIFE SUPPORT (BLS)
Competencies and skills:
Essential:
* Fleet Safety
Education:
Essential:
* BACHELOR'S DEGREE
Other information:
Minimum Requirements:
Master’s degree in Social Work
Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC)
Basic Life Support (BLS)
Fleet Safety Clearance
Fingerprint Clearance Card
Minimum of 2 years’ experience in behavioral health utilization review.
Experience in EMRs.
Join us at Yuma Regional Medical Center dba Onvida Health
A career at Onvida Health is more than just a job. It’s a place to have a long and rewarding career, making a difference in the lives of those in our shared community. When you join our team, you become an integral part of a thriving community committed to improving the health and well-being of everyone in southwestern Arizona.
At Onvida Health, we believe in progress with purpose. Our commitment to innovation is matched by our dedication to kindness and integrity. We take our values seriously because we know they lead to better outcomes for our patients and a better experience for all of us. We’re looking for people who approach each day with a sense of possibility, a drive to make things better, and a commitment to kindness. If that sounds like you, you’re our kind of people.
If you’re looking for a career where innovation meets compassion, where you can grow and contribute to building a healthier tomorrow, Onvida Health is the place for you.
Life in Yuma, Arizona
Yuma, recognized by Guinness World Records as the Sunniest City on Earth, offers more than just sunshine. It’s a place where the great outdoors meets a welcoming, tight-knit community. Hike scenic trails, explore the Colorado River, or immerse yourself in local cultural festivals – all while embracing the beauty of this desert oasis. With easy access to larger cities and popular destinations, Yuma makes it easy to balance a fulfilling career with time for personal adventures and relaxation.
Physical Requirements and working conditions for this position will be provided to you up on interview.