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Utilization Review SpecialistCadence Care Network • Niles, Illinois, United States
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Utilization Review Specialist

Cadence Care Network
  • US
    Niles, Illinois, United States
  • US
    Niles, Illinois, United States
Apply Now

About

Job description Cadence Care Network believes in building a cohesive team of managers and staff. We know that our employees are our most valuable assets in delivering quality service to the children and families that we serve. It is our collective goal to evolve, providing quality services to meet the ever-changing needs of the community. The Utilization Review Specialist is responsible for obtaining, tracking, and managing prior authorizations for behavioral health and/or medical services in accordance with payer-specific requirements This role supports timely access to care, verifies medical necessity and documentation requirements, monitors authorization thresholds and reauthorization needs, minimizes denials, and helps ensure accurate reimbursement and compliance with Medicaid, Medicare, Managed Care, and commercial insurance guidelines. Required Qualifications: • High school diploma or equivalent required.
Preferred Qualifications: • Associate degree in Healthcare Administration, Medical Billing and Coding, Health Information Management, Business Administration, Behavioral Health, Social Work, or a related field preferred. • Bachelor's or master's degree in healthcare administration, behavioral health, social work, business administration, public health, or a related field is preferred.
  • Niles, Illinois, United States

Languages

  • English
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