Utilization Review Specialist-Outpatient Substance Abuse Facility

Responsibilities:
- Review medical records to determine the medical necessity and appropriateness of healthcare services
- Conduct Utilization Reviews and make recommendations for the approval or denial of services based on established criteria
- Collaborate with healthcare providers to gather additional information and clarify documentation as needed
- Ensure compliance with regulatory guidelines and insurance requirements
- Document all review activities accurately and thoroughly

Skills:
- Strong knowledge of medical terminology, procedures, and diagnoses
- Familiarity with medical office operations and workflows
- Excellent analytical and critical thinking skills
- Attention to detail and ability to work independently
- Effective communication and interpersonal skills

As a Utilization Review Specialist, you will play a crucial role in evaluating the medical necessity of healthcare services and ensuring appropriate utilization. Your expertise in medical records, medical office operations, and medical terminology will be essential in conducting thorough reviews and making informed recommendations. Strong analytical skills, attention to detail, and effective communication will enable you to collaborate effectively with healthcare providers and ensure compliance with regulatory guidelines. Join our team today and contribute to the delivery of high-quality, cost-effective healthcare services.

Job Type: Full-time

Pay: $45,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work Location: Remote