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Gosnold, Inc. has been a nationally accredited non-profit leader in the prevention, treatment and recovery of mental health and substance use disorders for over 50 years. We offer a full, end-to-end continuum of care offering a wide range of treatment options. Highly regarded for innovation, we offer a comprehensive patient centered continuum of care tailored to fit the needs of each individual. Gosnold welcomes like-minded individuals who are passionate about our mission to support people and families affected by these disorders, and to promote lasting recovery.
SUMMARY:
The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification requirements of each patient’s insurance plan. This position requires daily communication with Patient Financial Services to ensure that every patient is covered for their stay. The Utilization Review Specialist must have experience working on interdisciplinary treatment teams.
ESSENTIAL JOB FUNCTIONS/DUTIES/RESPONSIBILITIES:MINIMUM KNOWLEDGE, EXPERIENCE, AND SKILLS REQUIRED:
The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform the job.
Certificates, Licenses, and Registrations: N/A
BENEFITS (based on full-time employment):
Gosnold is an Equal Opportunity Employer .
COVID-19 Statement:
In accordance with CDC guidelines, Gosnold maintains strict standards when it comes to protecting our staff, patients, and residents, and offers a variety of personal protective equipment to ensure a safe and stress-free workplace.
Full Time
$80k-104k (estimate)
05/01/2024
05/18/2024
gosnold.org
FALMOUTH, MA
200 - 500
1972
Private
RAYMOND TAMASI
<$5M
Ambulatory Healthcare Services
The following is the career advancement route for Utilization Review Specialist (Hybrid) positions, which can be used as a reference in future career path planning. As an Utilization Review Specialist (Hybrid), 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 (Hybrid). You can explore the career advancement for an Utilization Review Specialist (Hybrid) 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.