Competitive salary commensurate with experience; c...
Admission and concurrent utilization reviews
Insurance authorization coordination
Appeals process management for denials
The Utilization Specialist is responsible for reviewing admissions, continued stays, and discharge planning according to approved clinically valid criteria
Job Summary
The Utilization Specialist is responsible for reviewing admissions, continued stays, and discharge planning according to approved clinically valid criteria.
Candidates must effectively communicate with insurance companies and physicians to secure approvals for inpatient days and manage the appeals process for denials.
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 admissions, continued stays, and discharge planning according to approved clinically valid criteria.
Salary
Competitive salary commensurate with experience; Comprehensive benefit plan included
Skills & Requirements
Must-have
Admission and concurrent utilization reviews
Insurance authorization coordination
Appeals process management for denials
Medical necessity documentation
Physician communication for treatment approval
Nice-to-have
Statistical reporting on utilization trends
Peer review call facilitation
Staff training on charting requirements
Collaborative problem solving with business office
Key Requirements
Graduation from accredited nursing or social work school
Two or more years of direct clinical psychiatric experience
Current licensure as LPN, RN, or clinical professional license
Bachelor's degree in behavioral or mental health field