Not specified (likely on-site due to the nature of the role).
Review admissions and continued stays
Obtain authorizations
Communicate with insurance companies
The Utilization Review Specialist at Anabranch Recovery Center is responsible for managing utilization review processes, ensuring compliance with clinical criteria, and coordinating with healthcare providers and insurance companies. The role requires experience in clinical settings, particularly in substance abuse, and involves ongoing education and support for hospital staff
Job Summary
The Utilization Specialist is responsible for reviewing of 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.
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: 85
The Utilization Review Specialist at Anabranch Recovery Center is responsible for managing utilization review processes, ensuring compliance with clinical criteria, and coordinating with healthcare providers and insurance companies. The role requires experience in clinical settings, particularly in substance abuse, and involves ongoing education and support for hospital staff.
Skills & Requirements
Must-have
review admissions and continued stays
obtain authorizations
communicate with insurance companies
appeal denials
maintain accurate documentation
Nice-to-have
support and training for staff
quality reviews for medical necessity
liaison between managed care organizations
Key Requirements
High School diploma or equivalent
One or more years of direct clinical experience
At least one year experience in utilization review