2 Jobs in Miami, FL
Evolutions Treatment Center is Hiring an Utilization Review Specialist Near Miami, FL
**Overview:**
We are seeking a dedicated Utilization Review Specialist to join our healthcare team. The ideal candidate will be responsible for reviewing medical records and ensuring that patients receive appropriate care based on medical necessity and established guidelines.
**Duties:**
- Conduct utilization reviews and level of care certifications for PHP and IOP patients.
- Evaluate clinical information to ensure medical necessity and compliance with insurance guidelines.
- Collaborate with clinical staff to gather necessary documentation and information.
- Communicate with insurance companies to obtain prior authorizations and continued stay approvals.
- Maintain detailed records of reviews, authorizations, and communications.
- Assist in the development and implementation of utilization management policies and procedures.
- Provide education and support to clinical staff regarding utilization review processes and requirements.
- Participate in quality improvement initiatives and ensure compliance with regulatory standards.
- Act as a liaison between the treatment center and insurance providers.
**Requirements:**
- Bachelor’s degree in Nursing, Social Work, or a related field; Master’s degree preferred.
- Current licensure as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or equivalent preferred but not required.
- Minimum of 2 years of experience in utilization review or a related field, preferably in a substance abuse or mental health setting.
- Knowledge of PHP and IOP levels of care and associated insurance protocols.
- Excellent analytical, organizational, and communication skills.
- Familiar with ASAM criteria and Locus assessment.
- Ability to work independently and collaboratively in a team environment.
- Proficient in the use of electronic health records (EHR) and utilization management software.
- Proficient in Excel.
Job Type: Full-time
Pay: From $50,000.00 per year
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: Hybrid remote in Miami, FL 33162
Job Summary
Full Time
Medical Technology
$77k-96k (estimate)
05/23/2024
09/18/2024
evolutionstreatment.com
FORT LAUDERDALE, FL
<25
2020
<$5M
Medical Technology
Related Companies
About Evolutions Treatment Center
Evolutions Treatment Center provides comprehensive treatment of addiction and co-occuring psychiatric disorders. We offer a luxurious setting combined with a world-class team of addiction treatment and behavioral health professionals. Treatment consists of a diverse blend of evidenced based and holistic methodology. Our program recognizes the connection of mind, body, and spirit, treating the full spectrum of addiction and it's underlying causes. All services are supervised by a licensed clinical psychologist and physicians board certified in psychiatry, addiction medicine, sleep, and other sp ...
ecialties. Our experienced, licensed, credentialed staff and independent specialists also include licensed clinical social workers, licensed mental health counselors, nurses, certified yoga instructors, certified trainers, and other specialty areas. At Evolutions Treatment Center we provide affordable luxury care in a warm nurturing environment; combined with cutting edge treatment and assessment. The only thing left to ask yourself isAre you ready to Evolve?
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The job skills required for Utilization Review Specialist include Utilization Management, Social Work, Prior Authorization, Quality Improvement, Initiative, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Specialist positions, which can be used as a reference in future career path planning. As an Utilization Review Specialist, it can be promoted into senior positions as an Utilization Review Manager - Home Care that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Specialist. You can explore the career advancement for an Utilization Review Specialist below and select your interested title to get hiring information.
If you are interested in becoming an Utilization Review Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become an Utilization Review Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Utilization Review Specialist job description and responsibilities
Utilization Review Specialists ensure that Doctors and Nurses choose only the best treatments for them.
03/11/2022: Fort Myers, FL
Utilization review typically refers to the review of services that have already been delivered, while utilization management often refers to the review of coverage for future medical services.
02/16/2022: Louisville, KY
Assess plans for patient care and determine what treatment is appropriate and most cost-effective
02/15/2022: Augusta, GA
Analyze electronic medical records, and inform medical staff whether a medical claim is denied,
03/11/2022: Boston, MA
Prepares and submits regular reports on utilization control and on review activities.
02/26/2022: Reading, PA
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Utilization Review Specialist jobs
Know where to find utilization review jobs.
03/13/2022: Clarksville, TN
Create a utilization review cover letter.
02/18/2022: Reno, NV
Sign up for free credit monitoring.
03/16/2022: New London, CT
Set up documentation shortcuts.
03/05/2022: Lawton, OK
Take the certification examination.
05/08/2022: New Bedford, MA
Step 3: View the best colleges and universities for Utilization Review Specialist.
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