Utilization Specialist - Op

Peak Behavioral Health

Santa Teresa, New Mexico, US
Competitive salary commensurate with experience; n...
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Reviewing admissions and continued stays
Communicating with insurance companies
Appealing claim denials
** Peak Behavioral Health is seeking a Utilization Specialist to oversee admission reviews, discharge planning, and utilization management practices in Santa Teresa, New Mexico. The ideal candidate will have a background in nursing or social work and experience in psychiatric or mental health settings. **

Job Summary

  • The Utilization Specialist is responsible for reviewing admissions, continued stays, and discharge planning using clinically valid criteria to obtain authorizations.
  • This role involves communicating effectively with insurance companies and physicians to secure approval for inpatient days and manage the appeal process for denials.
  • Peak Behavioral Health offers a comprehensive benefit plan and competitive salary while serving Veterans through specialized programming.

Matching Summary

Match Score: 75

** Peak Behavioral Health is seeking a Utilization Specialist to oversee admission reviews, discharge planning, and utilization management practices in Santa Teresa, New Mexico. The ideal candidate will have a background in nursing or social work and experience in psychiatric or mental health settings. **

Salary

Competitive salary commensurate with experience; Not specified; Comprehensive benefit plan included

Skills & Requirements

Must-have

  • Reviewing admissions and continued stays
  • Communicating with insurance companies
  • Appealing claim denials
  • Verifying patient benefits
  • Monitoring length of stay

Nice-to-have

  • Experience with managed care organizations
  • Training staff on documentation
  • Collaborating with multi-disciplinary teams
  • Statistical reporting skills

Key Requirements

  • Bachelor's degree in social work or related field
  • Two or more years of psychiatric clinical experience
  • Current LPN, RN, or clinical license in New Mexico

Work Rights

Not specified

Tailored Resume

Cover Letter