Utilization Review Specialist
Oaks Integrated Care
1 hour ago
Full-time
On-site
Trenton, New Jersey, United States
$55,000 - $55,000 USD yearly
Registered Nurse
Join our team today and immerse yourself in a rewarding career for years to
come!
As the Utilization Review Specialist, you will work in an office based setting
located in Trenton, Mercer County NJ.
The Utilization Review Specialist is responsible for all aspects of the
authorization of treatment via insurance and managed care companies. The
Utilization Review Specialist provides appropriate client information to payers
regarding the medical necessity of treatment in a timely manner. The Utilization
Review Specialist will also perform pre-certification reviews, concurrent
reviews and will perform appeal reviews as needed.
Pay: $55,000
Schedule: Full-time; Monday-Friday 8:30am-5:00pm; 30 min unpaid lunch
Responsibilities:
* Requesting and obtaining prior authorizations for treatment services from
entities including, but not limited to, Medicaid, Managed Care Organizations,
NJSAMS, Commercial Insurance, EAP, etc..
* Facilitating prior authorization requests and concurrent reviews with all
payer sources for clients enrolled in services that require authorizations
for care.
* Managing and tracking prior authorization approvals and requests for all
clients enrolled and ensuring prior authorization/approval for services are
obtained in a timely manner from payer sources to ensure no gaps in care or
coverage.
* Coordinating with program leadership and staff to ensure clinical
documentation (Progress notes, Treatment Plans, etc..) is completed timely
and contains sufficient clinical content for prior authorization services.
* Engaging in Continued Stay Reviews with program leadership and staff to
determine justification for continuation of care.
* Coordinating with Accounts Receivable and Program Leadership to manage and
track all outgoing requests and receipts of authorizations as well as
managing pending requests.
* Verifying insurance coverage for enrolled clients and coordinating with
program leadership and AR to ensure there is a source of payment for all
clients receiving care.
* Facilitating Presumptive eligibility process for eligible clients.
* Other duties as assigned.
Benefits:
* Competitive salary
* Supplemental income
* Medical, Dental, Vision, 403(b)
* Generous paid time off benefits
* Opportunity for personal and career growth
* Team oriented environment – we practice the FISH! Philosophy
Qualifications:
* Bachelor's Degree required in psychology/human services/nursing/healthcare or
related field; Master's Degree Preferred in Behavioral Health/HealthCare or
related field; OR LPN or RN
* Minimum 2 years of relevant experience in a behavioral health or healthcare
setting.
* Knowledgeable about behavioral health services including ambulatory services
such as Outpatient, Partial Care, and Addictions treatment.
* Knowledgeable about healthcare claims and processing including prior
authorizations, CPT codes, MCOs, Medicaid, etc..
* Proficient in use of technology, various applications including Microsoft
Office (including Excel), Electronic Health Records, and other data bases
such as NJSAMs and Navinet.
* Strong skills related to clinical documentation
* Strong organizational and time management skills
* Excellent written and verbal communication, as well as interpersonal skills.
* Valid driver’s license in good standing required.
All positions require a valid driver’s license in good standing, and
pre-employment drug screening. All candidates, if hired, will be expected to
cooperate with Oaks Integrated Care and The Department of Human Services in all
inspections and investigations. Oaks Integrated Care considers applicants for
all positions without regard to: race; color; religion; sex; national origin;
age; sexual orientation; marital or veteran status; the presence of a medical
condition, genetic information or handicap, unrelated to performing the tasks of
the job; or any other legally protected status.
come!
As the Utilization Review Specialist, you will work in an office based setting
located in Trenton, Mercer County NJ.
The Utilization Review Specialist is responsible for all aspects of the
authorization of treatment via insurance and managed care companies. The
Utilization Review Specialist provides appropriate client information to payers
regarding the medical necessity of treatment in a timely manner. The Utilization
Review Specialist will also perform pre-certification reviews, concurrent
reviews and will perform appeal reviews as needed.
Pay: $55,000
Schedule: Full-time; Monday-Friday 8:30am-5:00pm; 30 min unpaid lunch
Responsibilities:
* Requesting and obtaining prior authorizations for treatment services from
entities including, but not limited to, Medicaid, Managed Care Organizations,
NJSAMS, Commercial Insurance, EAP, etc..
* Facilitating prior authorization requests and concurrent reviews with all
payer sources for clients enrolled in services that require authorizations
for care.
* Managing and tracking prior authorization approvals and requests for all
clients enrolled and ensuring prior authorization/approval for services are
obtained in a timely manner from payer sources to ensure no gaps in care or
coverage.
* Coordinating with program leadership and staff to ensure clinical
documentation (Progress notes, Treatment Plans, etc..) is completed timely
and contains sufficient clinical content for prior authorization services.
* Engaging in Continued Stay Reviews with program leadership and staff to
determine justification for continuation of care.
* Coordinating with Accounts Receivable and Program Leadership to manage and
track all outgoing requests and receipts of authorizations as well as
managing pending requests.
* Verifying insurance coverage for enrolled clients and coordinating with
program leadership and AR to ensure there is a source of payment for all
clients receiving care.
* Facilitating Presumptive eligibility process for eligible clients.
* Other duties as assigned.
Benefits:
* Competitive salary
* Supplemental income
* Medical, Dental, Vision, 403(b)
* Generous paid time off benefits
* Opportunity for personal and career growth
* Team oriented environment – we practice the FISH! Philosophy
Qualifications:
* Bachelor's Degree required in psychology/human services/nursing/healthcare or
related field; Master's Degree Preferred in Behavioral Health/HealthCare or
related field; OR LPN or RN
* Minimum 2 years of relevant experience in a behavioral health or healthcare
setting.
* Knowledgeable about behavioral health services including ambulatory services
such as Outpatient, Partial Care, and Addictions treatment.
* Knowledgeable about healthcare claims and processing including prior
authorizations, CPT codes, MCOs, Medicaid, etc..
* Proficient in use of technology, various applications including Microsoft
Office (including Excel), Electronic Health Records, and other data bases
such as NJSAMs and Navinet.
* Strong skills related to clinical documentation
* Strong organizational and time management skills
* Excellent written and verbal communication, as well as interpersonal skills.
* Valid driver’s license in good standing required.
All positions require a valid driver’s license in good standing, and
pre-employment drug screening. All candidates, if hired, will be expected to
cooperate with Oaks Integrated Care and The Department of Human Services in all
inspections and investigations. Oaks Integrated Care considers applicants for
all positions without regard to: race; color; religion; sex; national origin;
age; sexual orientation; marital or veteran status; the presence of a medical
condition, genetic information or handicap, unrelated to performing the tasks of
the job; or any other legally protected status.