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Utilization Review (UR) Specialist

NewVista Healthcare -
Blue Ash, OH

Quick Apply

Job Details

Full-time

Benefits

Health savings account
Paid holidays
Flexible spending account
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Loan forgiveness
Life insurance

Qualifications

High school diploma or GED

Full Job Description

Job Address:

10123 Alliance Road, Suite 320 Blue Ash, OH 45242

UR Specialist.

Shift: M-Fr 8-5

This is not a remote position. It is an office-based position in Cincinnati, Ohio.

Who we are

At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.

The Role Itself

Position Summary: The Utilization Review Specialist is responsible for the authorizations and certifications process for Inpatient and Outpatient Services. This includes the precertification and recertification process, peer to peer reviews, and appeal. The UR Specialist will accurately report the authorization status of patients, denials and appeals status to the Corporate Director of UR. The UR Specialist will follow department and department procedures and ensure effective communication with all relevant departments regarding patient care needs.

JOB RESPONSIBILITIES

As Utilization Review Specialist, you will :

Obtain Continued Stay Reviews for Inpatient and Outpatient behavioral health treatment.
Follow up on prior authorization submissions that need further information to obtain authorization.
Display knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization, and advocates on behalf of the patient to secure coverage for needed services.
Strong working knowledge of external review organizations (ie: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
Report appropriate denial and authorization information to designated resource.
Coordinate authorization information with third party payors in a timely manner.
Complete thorough and accurate documentation in all required systems.
Maintain communication system based on documentation and verbal exchange regarding treatment with other UM staff and staff at the facilities as needed.
Schedule and follow up on results of Peer to Peer requests for physicians and CNP.
Maintain Denial Log

Education

High school diploma or GED (Required), Bachelor’s Degree or Master’s Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field preferred.
Previous Utilization Review experience in a behavioral healthcare facility preferred.
License: LPN, RN, LSW, LPC, LCDC or applicable license preferred

Skills

Ability to multi-task
Strong organization skills
Strong problem-solving skills
Ability to work well independently and as part of a team

Perks at Work

Healthcare:

Medical Packages with Rx – 3 Choices
Flexible Spending Accounts (FSA)
Dependent Day Care Spending Accounts
Health Spending Accounts (HSA) with a company match
Dental Care Program – 2 choices
Vision Plan
Life Insurance Options
Accidental Insurances
Paid Time Off + Paid Holidays
Employee Assistance Programs
401k with a Company Match

Education + Leadership Development

Up to $15,000 in Tuition Reimbursements
Student Loan Forgiveness Programs

Our overall mission is to Inspire Hope, Restore Peace of Mind and Heal Lives.

Quick Apply

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