Utilization Review Specialist
Job Description
Job DescriptionPraesum Healthcare: Position Title: Utilization Review Specialist Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers in key geographical locations throughout the Northeast, mid-Atlantic, and Southeast regions. Praesum is an established leader in the healthcare industry. With a solid, growth-focused business model, strong finances, and expert management team, Praesum will continue to grow in the years to come. Praesum currently provides services to behavioral health facilities providing all levels of care from inpatient psychiatric and substance abuse detoxification, through SUD and mental health outpatient clinics. Utilization Review Specialist Job description: Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings. Utilization Review Specialist Duties/Responsibilities: • Initiate pre-certification and continued stay authorizations based on ASAM criteria • Communicate directly with facility regarding patients’ needs and symptomology • Maintain daily census scheduling all new admissions and concurrent reviews • Input of authorizations and appropriate demographic information to EHR for billing purposes • Completing “peer to peer” reviews and scheduling “Doctor to Doctor” reviews when needed • Confirm insurance coverage of each patient • Organize weekend census of all detox and residential patients for all our impatient facilities • Collect all appropriate clinical data for each patient that requires precertification Utilization Review Specialist Requirements: • High School Diploma • A minimum of 3-5 years of utilization review experience. • Individual must be computer literate with proficiency in Microsoft Office applications. Utilization Review Specialist Schedule: • Full Time • 8:30am to 5:00pm Utilization Review Specialist Compensation: • Hourly rate competitive with experience and location Full time employees may be eligible for the following: • Insurance: Medical, Dental, Vision, and STD options • Medical FSA and Dependent Care Account • 401k with company match up to 5% • Accrued Paid Time Off (PTO) • Education reimbursement • Career Advancement Opportunities *** This job does NOT sponsor visa's and we are unable to consider out of country applicants *** If you are interested in this opportunity or know someone that you respect who would be a good fit for this position, please email: Clay- Clay@praesumhealthcare.com Healthcare Recruiter James- James@praesumhealthcare.com Healthcare Recruiter #IND123Company DescriptionFounded in 2003, Praesum Healthcare provides administrative services for healthcare providers spanning critical geographical locations throughout the country. Praesum has serviced over 49,000 patients in various stages of health care services.
With an established business model, healthy finances, expert industry management team, and proven networking capabilities, Praesum looks to prosper in the $11.6 billion industry (2014 industry revenue forecast).
Company Description
Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers spanning critical geographical locations throughout the country. Praesum has serviced over 49,000 patients in various stages of health care services.\r\n\r\nWith an established business model, healthy finances, expert industry management team, and proven networking capabilities, Praesum looks to prosper in the $11.6 billion industry (2014 industry revenue forecast).