Utilization Review Specialist

2 months ago


Irvine, North Ayrshire, United Kingdom Newport Healthcare Full time

About Newport Healthcare

Newport Healthcare is a leading provider of behavioral healthcare services dedicated to delivering high-quality, patient-centered care. Our team of experts is committed to transforming lives through evidence-based treatment and innovative approaches.

Job Summary

We are seeking a skilled Utilization Review Specialist to join our team. The successful candidate will be responsible for managing an active caseload of clients, acting as a liaison between insurance companies, clients, and clinical teams, and communicating updates to relevant stakeholders.

Key Responsibilities

  • Coordinate and complete initial, concurrent, and retrospective reviews to ensure continuous coverage and optimize benefits.
  • Communicate plans of care to insurance case managers, facility staff, and healthcare partners.
  • Maintain contact with clients' families and keep them updated on current insurance authorization updates, peer reviews, and denials.
  • Document all activities in a detailed manner in applicable CRM/EMR.
  • Collaborate with clinicians and the multidisciplinary team daily to obtain necessary clinical documentation for reviews and ensure effective utilization of resources.
  • Participate in weekly treatment team and continuing care meetings as appropriate.
  • Prepare and submit appeal documentation to the appropriate entities as indicated.
  • Complete weekly treatment team notes and provide updates to the psychiatrist as requested by the director/manager.

Requirements

  • At least two years of work experience in the behavioral health field.
  • Active license or credential in a behavioral health field preferred.
  • Bachelor's or Master's in a behavioral health-related specialty preferred.

Benefits

  • Medical/Dental/Vision
  • Company-paid life insurance
  • Voluntary STD/LTD
  • Flexible spending accounts

Newport Healthcare is an equal opportunity employer and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, genetic information, or any other characteristic protected by federal, state, or local laws.



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