Job Title: Utilization Review Specialist

Reports to: Utilization Review Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

Job Summary:

CodeMax Medical Billing is seeking to hire an experienced Utilization Review Specialists or Licensed Medical Clinicians to be trained as a Utilization Review Specialists. We specialize in Behavioral Health and Mental Health treatment Facilities that provide Detoxification, Residential Treatment, Partial Hospitalization, Intensive Outpatient, Outpatient Treatment, Eating Disorder Outpatient and Inpatient Programs, Mental Health Outpatient Programs.

As a Utilization Review Specialist, your skills in managing referrals, scheduling, communication, patient tracking, and documentation will be crucial. If you have a background as a clinical coordinator, referral coordinator, or are a licensed clinician, you're well-equipped with many of these skills and we encourage you to apply. Your experience in navigating complex medical systems, coordinating with diverse medical personnel, and ensuring seamless patient care is exactly what we need. In this role, you'll have an opportunity to apply these skills while focusing on optimizing patient service utilization, streamlining care delivery, and ensuring that our services meet the quality standards our patients deserve. While this position will certainly require understanding and managing insurance processes, it's also about making sure our patients get the right care, at the right time, in the right place. If you're ready to take your healthcare coordination skills to the next level, we would be delighted to receive your application.

Duties/Responsibilities:

• Collaborates with the clinical team to determine coverage and length of stay.

• Utilizes clinical information and knowledge of Behavioral and Mental Health Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and health care partners.

• Collaborates in Continuing Care planning.

• Works with facility staff to ensure timely admissions.

• Prepares and submits appeals documentation to the appropriate entities as indicated.

• Submits and reports insurance authorization according to company policy.

• All other duties as assigned.

Required Skills/Abilities:

• Proficiency in healthcare management systems and Microsoft Office Suite.

• Strong organizational and multitasking skills.

• Excellent verbal and written communication abilities.

Education And Experience:

• 1 year of experience in Behavioral Healthcare or any other medical field with a rigorous preauthorization process.

• Medical or Clinical License (Required); LMFT, AMFT, CADC, RN, LPN

Or

• A minimum of 1 year of experience in Behavioral Healthcare or any other medical field with a rigorous preauthorization process.

• A minimum of 1 year of experience in Behavioral Healthcare Utilization Review or any other medical field with a rigorous preauthorization process.

• Medical or Clinical License (preferred); LMFT, AMFT, CADC, RN, LPN

Or

• A minimum of 1 year of experience in Behavioral Healthcare or any other medical field with a rigorous preauthorization process. A minimum of 1 year of experience as a Referral Coordinator or Clinical Coordinator in Behavioral Healthcare or any other medical field with a rigorous preauthorization process.

Benefits

• Health Insurance

• Vision Insurance

• Dental Insurance

• 401(k) plan with matching contributions