Utilization Review Specialist

Acme Billing Solutions Franklin, Tennessee
utilization utilization review insurance utilization utilization review ur management advocacy medical providers health team compliance
December 22, 2022
Acme Billing Solutions
Franklin, Tennessee
FULL_TIME

The Utilization Review Specialist is responsible for prospective, retrospective, and concurrent utilization review activities to reflect client and care advocacy. They are a member of the multidisciplinary team and monitors documentation in the medical record for accuracy and clinical compliance.
Essential Function/Job Duties

  • Comfortable working with common billing and EMR/EHR software
  • Familiar with both inpatient and outpatient levels of care
  • Maximize authorizations from insurance providers for all levels of care
  • Is knowledgable of common medical necessity criteria
  • Conduct reviews in a timely manner for each patient
  • Manage utilization review schedule with providers
  • Report and resolve any issues that affect authorizations
  • Experience in mental health, chemical dependency, or psychiatric nursing
  • Experience with peer-to-peer reviews +
  • Attends UR meetings to discuss activities/needs of UR department
  • Interacts with third-party payers, managed care organizations, and gatekeeper organizations
  • Works closely with clinical staff and provides feedback regarding findings that may benefit reviews
  • Ability to speak clearly and persuasively in positive or negative situations
  • Good 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

Competencies

  • Thoroughness/Critical thinking skills
  • Time management
  • Project Management
  • Problem Solving/Analysis
  • Communication Proficiency
  • Advocacy

Preferred Experience:

  • One year of experience as a UR specialist

Office Location Pending. Inquire for more information.

Job Type: Full-time

Pay: $50,000.00 - $65,000.00 per year

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Flexible schedule
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:

  • Monday to Friday

Ability to commute/relocate:

  • Franklin, TN 37067: Reliably commute or planning to relocate before starting work (Required)

Experience:

  • Utilization management: 1 year (Preferred)

Work Location: One location


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