Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.

Qualifications

Education: Bachelor's degree or current clinical license preferred



Experience: Previous utilization review experience in a psychiatric healthcare facility preferred



License: Current unencumbered clinical license and valid driver's license preferred



Additional Requirements: CPR Certification and Handle with Care training preferred

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