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Utilization Review Specialist

Remote: 
Full Remote
Contract: 
Salary: 
19 - 19K yearly
Experience: 
Junior (1-2 years)
Work from: 
Canada, California (USA), United States

Offer summary

Qualifications:

Experience in healthcare preferred, Minimum one year in utilization review, Familiar with billing and EMR/EHR software, Knowledgeable of standard medical necessity criteria, Solid command of Microsoft Office applications.

Key responsabilities:

  • Evaluate patient medical records for necessity
  • Analyze utilization data for improvement trends
  • Manage utilization review schedule and authorizations
  • Communicate with providers and insurance companies
  • Prepare and submit reports to management
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Assembly Health
201 - 500 Employees
See more Assembly Health offers

Job description

Become an Assembler! We are looking for a Utilization Review Specialist to join Assembly Health. If you are looking for a company that is focused on being the best in the industry, love being challenged, and make a direct impact on our business, then look no further! We are adding to our motivated team that pride themselves on being client-focused, biased to action, improving together, and insistent on excellence and integrity.

This is a full-time, non-exempt position reporting to the U/R Manager.

What you'll do

  • 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 services as necessary, providing appropriate clinical information and documentation.
  • Attends UR meetings to discuss activities/needs of UR department
  • Execute additional duties as assigned, demonstrating diligence and meticulous attention to detail.

What we're looking for

  • 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.

Why join the team?

  • Be part of something special! We are growing both organically and through acquisitions.
  • Career growth - your next role with Assembly might not be created yet and we are waiting for your help to chart the way!
  • Ongoing training and development programs.
  • An environment that values transparency
  • Competitive Benefit Packages available, Paid Holidays, and Paid Time Off to enjoy your time away from the office.

Required profile

Experience

Level of experience: Junior (1-2 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Microsoft Office
  • Time Management
  • Self-Motivation
  • Accountability
  • Quick Learning
  • Organizational Skills
  • Lifting Ability
  • Ability To Meet Deadlines
  • Detail Oriented
  • Social Skills
  • Non-Verbal Communication

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