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Greenleaf Behavioral Health Hospital
Overview
The role involves monitoring patient service utilization to optimize facility reimbursement and acting as a liaison between managed care organizations and clinical staff. Key duties include conducting medical necessity reviews, managing the appeal process for denied stays, and providing staff training on documentation requirements.
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Compensation
Salary not listed
Posted
25 days ago
Conway Behavioral Health
1 month ago
Heart and Vascular Care Inc
The specialist is responsible for obtaining complete and accurate insurance information, verifying benefits, and accurately interpreting benefit plans to ensure proper authorization for procedures. Duties also include explaining financial responsibilities to patients and maintaining accurate documentation of authorizations and related information.
2 months ago
San Jose Behavioral Health
The Utilization Review Specialist coordinates and assesses inpatient census for appropriate alternate health care service needs, performing concurrent review and pre-certification according to authorization guidelines. Responsibilities also include coordinating discharge planning, providing documentation feedback, and acting as a resource to the clinical team on approved criteria and treatment options.
$33 - $60 / HOUR
Acadiana Treatment Center
The Utilization Review Specialist acts as a liaison between managed care organizations and clinical staff, conducting reviews according to certification requirements and coordinating communication regarding reimbursement. This role involves monitoring patient length of stay, gathering utilization data, conducting quality reviews for medical necessity, and facilitating peer reviews.
$31 - $50 / HOUR
Serenity Knolls
The specialist will proactively monitor service utilization to optimize facility reimbursement by acting as a liaison between managed care organizations and clinical staff, conducting necessary reviews, and managing communication regarding reimbursement requirements. Key duties include monitoring patient length of stay, gathering utilization statistics, conducting quality reviews for medical necessity, facilitating peer reviews, and managing the appeal process for denied stays.
Quadax, Inc.
The Appeals Specialist is responsible for reviewing denials and EOBs, determining appeal strategies based on case history and payer requirements, and preparing and submitting appeal documentation. This role also involves coordinating hearings and ensuring compliance with all levels of the appeal process while meeting filing deadlines.
Seven Hills Hospital
The Utilization Specialist proactively monitors service utilization to optimize facility reimbursement by acting as a liaison between managed care organizations and clinical staff. Key duties include conducting utilization reviews, monitoring length of stay, gathering utilization data, facilitating peer reviews, and managing the formal appeal process for denials.
The Appeals Specialist is responsible for reviewing denials and gathering necessary information to determine and execute the appropriate appeal strategy, including creating appeal letters and coordinating hearings. This role requires strict compliance with all levels of the appeal process and meeting established filing deadlines and productivity goals.
3 months ago
The Camp Recovery Center
The Utilization Specialist acts as a liaison between managed care organizations and clinical staff, conducting reviews for reimbursement requirements and monitoring patient length of stay. Key duties include gathering utilization statistics, conducting quality reviews for medical necessity, facilitating peer review calls, and managing the formal appeal process for denied stays.
$25 - $27 / HOUR
The Utilization Review Specialist acts as a liaison between managed care organizations and clinical staff, conducting reviews to ensure compliance with reimbursement requirements and monitoring patient length of stay. Key duties involve gathering utilization data, conducting quality reviews for medical necessity, facilitating peer reviews, and managing the formal appeal process for denials.
$25 - $37 / HOUR
Ascension St. Thomas Behavioral Health Hospital
The Utilization Specialist will monitor service utilization for patients to optimize facility reimbursement and act as a liaison between managed care organizations and clinical staff. Responsibilities include conducting reviews of insurance plans, monitoring patient length of stay, and facilitating peer review calls.
4 months ago
