- 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.
- Minimum 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.
-
Peer Review Specialist
1 day ago
St. Peter's Health Helena, United States Full timeThe Peer Review Specialist reports directly to the Medical Staff Services Officer and assists with all functions of the Medical Staff Services Department at St. Peter's Health. This position is an integral part of Medical Staff Services by developing processes for ongoing and foc ...
-
utilization review specialist
2 weeks ago
Shodair Children's Hospital Helena, United StatesShodair 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 ...
-
Patient Access Specialist
1 week ago
The Staff Pad Helena, United States Full timeThe Staff Pad is honored to partner with a non-profit healthcare system in Helena, Montana with superior care and a hometown commitment to be the gold standard for health care in Montana. · As a Patient Access Specialist (PAS), you will provide exceptional customer service and e ...
-
Accounts Payable Specialist
2 weeks ago
Pacific Union Co Saint Helena, United States**Title**:Accounts Payable Specialist · **Date**:April 2024 · **Reports To**:Accounting Supervisor · **Supervisory Responsibilities**:None · **Exempt ( ) Non-Exempt ( x )** · **OBJECTIVE**:The Accounts Payable Specialist is responsible for all aspects of the accounts payable cycl ...
-
SilverLion Inc Helena Valley Southeast, United StatesWe have interesting tasks for you in Helena Valley Southeast: · You will take on the construction management and supervision for various construction projects within the scope of construction, operation, and maintenance of our supply and communication networks · You are responsib ...
-
Administrative Rules
3 weeks ago
State of Montana Helena, United States Part timeInclude: Reviews draft administrative rules prepared by program staff and edits content to ensure proper format, grammar, and language/phrasing. Advises program and senior management regarding administrative rules requirements. Communicates with the Administrative, Part Time, Spe ...
-
Prior Authorization Specialist
2 weeks ago
St. Peter's Health Helena, United StatesJOB SUMMARY (overview of job): The primary function of the Prior Authorization Specialist position is to provide premier customer service to the patient, physician and office staff by obtaining facility authorizations for patients scheduled at SPH. This position will be required ...
-
Compliance Specialist
1 week ago
State of Montana Helena, United StatesThis position is open until filled with the first application review date of May 23, 2024. · This temporary position serves as an Application Reviewer (Compliance Specialist 1) for the Board of Housing Homeowner Assistance Fund Program. The position is being created to assist wit ...
-
Insurance Forms Compliance Specialist
3 weeks ago
State of Montana Helena, United States* This vacancy announcement is being readvertised and will remain OPEN UNTIL FILLED. The next review of applicants will take place on April 12, 2024, and each week thereafter. · The Montana State Auditor, Commissioner of Securities and Insurance (CSI), has an exciting opportunity ...
-
Compliance Specialist
3 weeks ago
State of Montana Helena, United StatesThis position will review applications and determine eligibility for assistance from the new complex federal program and report to the Homeowner Assistance Fund Program Supervisor. Compliance Specialist responsibilities include, but are not limited t Compliance Specialist, Compli ...
-
Senior Business Operations Specialist
1 week ago
Carroll College Helena, United States: Carroll College is seeking a self-motivated individual to fill the position of Senior Business Operations Specialist for the Finance & Administration Department. This position will perform senior executive level administrative support to the Vice President of Finance, Administr ...
-
Patient Access Specialist
1 week ago
St. Peters Health Helena, United StatesJOB SUMMARY: The role of a Patient Access Specialist (PAS) is to assist in providing seamless, patient-oriented and timely access to services provided at St. Peter's Health Medical Group (SPHMG) Clinics/Regional Medical Center. This position requires excellent customer service sk ...
-
Prior Authorization Specialist
1 week ago
St. Peter's Health Helena, United StatesJOB SUMMARY (overview of job): The primary function of the Prior Authorization Specialist position is to provide premier customer service to the patient, physician and office staff by obtaining facility authorizations for patients scheduled at SPH. This position will be required ...
-
Contracts Specialist, Federal Government
5 days ago
IMSolutions Helena, United StatesIMSolutions, LLC · Contracts Specialist, Federal Government - All Levels · Helena , · Montana · Apply Now · Contracts Specialist, Federal Government - All Levels · Remote · Full Time · Experienced · Share ) · IMSolutions seeks Contracts Specialists (Procurement/Acquisition) ...
-
Prior Authorization Specialist
1 week ago
St. Peter's Health Helena, United StatesJOB SUMMARY (overview of job): The primary function of the Prior Authorization Specialist position is to provide premier customer service to the patient, physician and office staff by obtaining facility authorizations for patients scheduled at SPH. This position will be required ...
-
Revolving Loan Program Specialist
3 weeks ago
State of Montana Helena, United StatesThis position is posted internal to Commerce only and first review will be Tuesday, May 14, 2024. · About the Department · The Department of Commerce aims to make sure Montana is the best place to work, live, and play. We work alongside private industry and local organizations to ...
-
Compliance Specialist
2 weeks ago
State of Montana Helena, United States: · This position is open until filled with the first application review date of May 23, 2024. · This temporary position serves as an Application Reviewer (Compliance Specialist 1) for the Board of Housing Homeowner Assistance Fund Program. The position is being created to assis ...
-
IT Project Specialist
2 weeks ago
State of Montana Helena, United States: · This first review of applications will be May 16, 2024. Please submit the following required documents on the State of Montana Careers website:Resume - Please include dates of employment and your supervisor's name/phone number for each position. · For a complete job descrip ...
-
Behavioral Health Care Coordinator
3 weeks ago
Center For Mental Health Helena, United StatesBehavioral Health Care Coordinator · Certified Community Behavior Health Clinic · Full-Time/Non-Exempt/Helena · Job Duties: Administers vital signs, review medical histories with clients, conduct UA and Saliva testing, triage phone calls, and client scheduling as needed. · Ensure ...
-
AIS Watercraft Inspector
1 week ago
State of Montana Helena, United StatesTHE OUTSIDE IS IN US ALL. · This position is open until filled and the first review of applications will be February 16, 2024. · A completed State Application is required. You must apply through the State of Montana Career site. · Special Information: · The Fisheries Division dev ...
utilization review specialist - Helena, United States - Shodair
Description
Job Description
Job DescriptionDescription: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:
If this sounds like you, please apply
Shodair 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
Requirements:EDUCATION, TRAINING AND EXPERIENCE