utilization review specialist - Helena, United States - Shodair Children's Hospital

Shodair Children's Hospital Helena, United States

5 days ago

Description

Shodair is looking to hire a new Utilization Review Specialist. Utilization Review primarily focuses on evaluating and managing the utilization of healthcare services, treatments, and procedures. It aims to ensure that the services provided are medically necessary, cost-effective, and aligned with established guidelines.

The ideal candidate is someone who:

Maintains knowledge of insurance plans requiring pre-authorizations and referrals in addition to Medicaid and third-party payor requirements, guidelines, and policies.

Promotes positive relationships, and ongoing communication and collaboration with Shodair's multi-disciplinary team and between community and statewide agencies, organizations, and mental health professionals.

Ability to determine and evaluate level of care criteria upon reviewing clinical data.

If this sounds like you, please applyShodair also offers a highly competitive wage and benefits package, including paid medical and vision insurance, a 6% employer paid 403b contribution, tuition assistance and student loan repayment options RequirementsEDUCATION, TRAINING AND EXPERIENCEMinimum qualifications include 2+ years of experience conducting utilization reviews or participating in the process in mental health.

Bachelor's degree in social work, psychology, nursing or related field preferred.
Working knowledge of regulatory and survey standards as it pertains to Medicaid, and private pay for clinical services.
Understanding of utilization review criteria and ability to apply consistently according to inter-rater reliability techniques.

Understanding of revenue cycle management as it pertains to the documentation requirements for and process of reimbursement for behavioral health clinical services.

Maintains a pleasant and professional demeanor in the workplace.

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