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Anabranch Recovery Center is seeking a Utilization Review Specialist to oversee admission, continued stay, and discharge planning processes in accordance with clinical criteria. The ideal candidate will have experience in clinical settings, particularly in substance abuse, and be proficient in communication with healthcare providers and insurance entities.
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Job Summary
The Utilization Specialist is responsible for reviewing 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.
Performs admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria and communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional days for treatment.
Anabranch Recovery Center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications.
Matching Summary
Match Score: 75
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Anabranch Recovery Center is seeking a Utilization Review Specialist to oversee admission, continued stay, and discharge planning processes in accordance with clinical criteria. The ideal candidate will have experience in clinical settings, particularly in substance abuse, and be proficient in communication with healthcare providers and insurance entities.
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Skills & Requirements
Must-have
admission and continued stay reviews
communication with insurance companies
appeals and denial management
documentation and file maintenance
staff training and support
Nice-to-have
clinical trend identification
discharge planning participation
quality review facilitation
liaison between payers and staff
Key Requirements
High School diploma or equivalent
One or more years of direct clinical experience
At least one year experience in utilization review