Utilization Specialist

Palms Behavioral Health

Harlingen, Texas, US
Review admissions and continued stays
Communicate with insurance companies
Appeal insurance denials
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes

Job Summary

  • The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes.
  • Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional inpatient days for treatment.
  • Palms Behavioral Health offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications.

Matching Summary

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes.

Skills & Requirements

Must-have

  • Review admissions and continued stays
  • Communicate with insurance companies
  • Appeal insurance denials
  • Maintain accurate documentation
  • Monitor patient length of stay

Nice-to-have

  • Educate hospital staff on requirements
  • Support and train staff on charting
  • Liaise between managed care and staff

Key Requirements

  • Graduation from approved/accredited school of nursing or Bachelor's degree
  • Two or more years direct clinical experience
  • Current LPN or RN licensure
  • Current clinical professional license or certification

Work Rights

Not specified

Tailored Resume

Cover Letter