Utilization Specialist

Palms Behavioral Health

Harlingen, Texas, US
Not specified
Admission and continued stay reviews
Communicate with insurance companies
Appeal denial processes
Palms Behavioral Health is seeking a Utilization Specialist in Harlingen, Texas, to manage and improve utilization review practices for inpatient stays, ensuring compliance with clinical criteria and effective communication with insurance providers. The role requires clinical experience in a psychiatric setting and offers competitive benefits

Job Summary

  • The Utilization Specialist is responsible for reviewing admissions, continued stays, utilization practices, and discharge planning according to approved clinically valid criteria to obtain authorizations and complete other pertinent processes.
  • This role involves coordinating, performing, and monitoring all utilization review/management activities of the hospital to continuously improve collection, reimbursement, coordination, and presentation of utilization review information.
  • Palms Behavioral Health offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications.

Matching Summary

Match Score: 85

Palms Behavioral Health is seeking a Utilization Specialist in Harlingen, Texas, to manage and improve utilization review practices for inpatient stays, ensuring compliance with clinical criteria and effective communication with insurance providers. The role requires clinical experience in a psychiatric setting and offers competitive benefits.

Skills & Requirements

Must-have

  • Admission and continued stay reviews
  • Communicate with insurance companies
  • Appeal denial processes
  • Maintain accurate documentation
  • Staff training on charting requirements

Nice-to-have

  • Collaborate with multidisciplinary teams
  • Liaison between payers and staff
  • Support for veterans and military families

Key Requirements

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

Work Rights

Not specified

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