Newport Healthcare is a nationwide behavioral healthcare organization dedicated to transforming young lives through evidence-based care. We have assembled the best teen and young adult mental health treatment staff in the country, and we want you to join us. While our experts guide our clients to sustainable healing, we support our valued staff members through industry-competitive salaries, career growth, skills expansion, student loan repayment, tuition reimbursement, and a commitment to diversity, equity, and inclusion. Be part of a team dedicated to providing compassionate care based on authentic connection, mutual respect, and unconditional love—and experience the rewards of making a difference in the lives of young people and their families each day.
Empowering Lives. Restoring Families.
Responsibilities
The Utilization Review Specialist is responsible for managing an active caseload of clients at the following Levels of Care: Detox, Residential, Partial Hospitalization, and Intensive Outpatient. They act as a liaison between insurance companies, the client, the client’s family, and the Clinical Team, and are responsible for communicating updates to appropriate representatives at the insurance company, the Clinical Team, and the client’s family as directed by the Manager/Director of Utilization Review. They gather required information, effectively case-build, and collaborate consistently with members of both the Utilization Review Team and interdisciplinary Treatment Team to ensure optimization of each client’s coverage and benefits.
1. Coordinate, schedule, and complete Initial, concurrent, Peer, and retrospective reviews in a timely manner to ensure continuous coverage, utilizing clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
2. Conduct and manage initial, concurrent, and discharge reviews to optimize benefits and utilization while representing the UR Department professionally and positively to other Departments and the company as a whole.
3. Maintain contact with the clients’ families and keep them updated on current insurance authorization updates, Peer Reviews, and Denials.
4. Document all activities in a detailed manner in applicable CRM/EMR.
5. Collaborate with Clinicians and the multidisciplinary team daily at both the Residential and Day Programs to obtain necessary clinical documentation for reviews and ensure effective utilization of resources.
6. Participate in weekly Treatment Team and Continuing Care Meetings as appropriate.
7. Prepare and submit Appeal documentation (including rationales) to the appropriate entities as indicated.
8. Complete weekly Treatment Team notes and provide updates to the Psychiatrist as requested by the Director/Manager.
9. Follow chain of command both within and outside of the Department.
Qualifications
1. At least two (2) years of work experience in the behavioral health field.
2. Active license or credential in a behavioral health field preferred.
3. Bachelor’s or Master’s in a behavioral health related specialty preferred.
Range for this position: $25.00 - $34.00 / hour
Shift: Mon-Fri 6:00am-2:30pm PST
Must be able to be on site one day per week.
Benefits include:
* Company Paid Life Insurance
* Voluntary STD/LTD
* Flexible Spending Accounts
Newport Healthcare is an Equal Opportunity Employer and is committed to ensuring equal employment opportunity, including providing reasonable accommodations to individuals with a disability. Applicants with a physical or mental disability who require a reasonable accommodation for any part of the application or hiring process please email.
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