Utilization Review Clinical Specialist

Requirements

• Active RN license, Licensed Clinical Professional Counselor (LCPC), or Licensed Certified Social Worker-Clinical (LCSW-C).
• Strong knowledge of payer requirements, clinical criteria and behavioral health diagnosis.
• Proven ability to analyze complex clinical documentation and craft persuasive medical necessity arguments.
• Exceptional organizational and analytical skills.
• Ability to communicate effectively with payors and providers to represent the needs of the patients.
• Attend patient focused rounds in order to present concrete and expert clinical knowledge on behalf of the patient and the health plans.
• Strong communication skills that allow for patient advocacy related to continued stay and discharge needs.
• Familiarity with denial management and software needed to deliver daily utilization review and appeal processes.
• Strong analytical skills to optimize care and reduce the need for avoidable care days.
• Essential computer skills which focus on EHR/EMR systems, data management, alongside core office skills like Microsoft Office (Excel, Word)

Benefits

• Comprehensive medical, dental and vision benefits for benefit eligible positions
• 403b retirement match
• Generous paid-time-off for benefit eligible positions
• Complimentary Employee Assistance Program (EAP)
• Generous mileage reimbursement program