Utilization Review Specialist

Enlightened Solutions – UTILIZATION REVIEW SPECIALIST

This is a full-time remote position for an addiction recovery center in Egg Harbor City NJ.

Experience:

This full time, NJ remote position will serve established substance abuse treatment and detox businesses that are expanding. The ideal candidate would have significant knowledge of ASAM criteria and proven success with utilization review for partial care and intensive outpatient treatment.

We offer excellent pay and a comprehensive benefits package including:

• Health and wellness benefits (e.g., medical, dental, vision, prescription)
• Time off benefits (10 vacation days upon hire, sick leave, Holiday pay.)
• Financial security benefits (Profit Sharing, 401(k), life insurance, etc.)
• FSA, DCA, employer funded HRA ...and more! Come join our team!

Responsibilities

• Knowledge of chemical dependency diagnosis and treatment process.
• Completes Initial, concurrent, Peer Reviews, Expedited Appeal Reviews, and retrospective reviews in a timely manner to ensure continuous coverage.
• Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
• Review and monitor utilization for members and plans, and implements solutions that directly influence quality of care and financial liability based on the needs of the member.
• Collaborate with treatment team to discuss clinical authorization and quality of care.
• Participates in clinical meetings, observation and interaction with clients to support concurrent reviews.
• Consistent and timely response to emails and other communications relating to utilization review.
• Prepare and submit Appeals.
• Other tasks or duties as assigned.

Requirements

• New Jersey Resident
• Bachelor’s degree from an accredited college or university (in behavioral health or related field preferred).
• 2 years of experience in the behavioral health field.
• Strong clinical skills.
• Must be detail oriented.
• Ability to handle multiple priorities with a sense of urgency.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Medical records: 2 years (Preferred)

Work Location: Remote