utilization review specialist

Utilization Review Specialist

About Us: New Hope Treatment Centers is a dynamic and innovative company focused on one thing - Change the world, one kid at a time, through the healing power of relationships. In our line of work, the need is great, and we're constantly growing to meet it. With a commitment to excellence and a focus on quality, we are dedicated to shaping the future of our industry. As we continue to grow and expand, we are seeking a dynamic and experienced Residential Counselor to join our team.

Since our opening in 1987, New Hope Treatment Centers has been a welcoming place for young people in moments of crisis. Our programs have played a role in countless success stories, thanks to our relational approach to behavioral care. We get to know our kids on an individual level, and work with them and their families toward a brighter next chapter. If any part of our mission has you inspired, we urge you to get in touch. It might be the best decision you make this year.

Essential Functions:

• Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
• Obtain retrospective, initial and continuing authorization for treatment services.
• Manage authorization denials including referral for peer review and appeals.
• Document and record all necessary information.
• Monitor and track new and ongoing authorization cases.
• Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
• Maintain confidentiality of patient information and adhere to HIPAA regulations.

Qualifications:

• 3-5 years Behavioral Health experience.
• Bachelor's or master's degree required.
• Superior written and oral communication skills
• Attention to detail to ensure necessary information is captured and properly documented.
• Ability to work independently and within a team.
• Ability to multi-task, prioritize and meet expected deadlines.
• Solid understanding of insurance benefits and coverages.
• Strong computer skills (Word, Excel)
• Understanding of mental and behavioral health treatment services.