Utilization Review (ur) Specialist

NewVista Behavioral Health

Blue Ash, OH, US
Fully remote
Authorization and certification process
Precertification and recertification
Peer to peer reviews
The Utilization Review Specialist is responsible for the authorizations and certifications process for Inpatient and Outpatient Services, including precertification, recertification, peer to peer reviews, and appeals

Job Summary

  • The Utilization Review Specialist is responsible for the authorizations and certifications process for Inpatient and Outpatient Services, including precertification, recertification, peer to peer reviews, and appeals.
  • This role requires knowledge of clinical criteria, managed care requirements, and external review organizations to advocate for patient coverage.
  • NewVista offers comprehensive benefits including medical packages, FSA/HSA with company match, tuition reimbursement, and student loan forgiveness programs.

Matching Summary

The Utilization Review Specialist is responsible for the authorizations and certifications process for Inpatient and Outpatient Services, including precertification, recertification, peer to peer reviews, and appeals.

Skills & Requirements

Must-have

  • Authorization and certification process
  • Precertification and recertification
  • Peer to peer reviews
  • Denials and appeals status
  • Clinical criteria knowledge

Nice-to-have

  • Inspire hope and deliver holistic care
  • Safe and healing environment
  • Work well independently and as part of a team

Key Requirements

  • High school diploma or GED required
  • Bachelor’s Degree or Master’s Degree preferred
  • Previous Utilization Review experience preferred
  • LPN, RN, LSW, LPC, LCDC license preferred

Work Rights

Not specified

Tailored Resume

Cover Letter