Utilization Management Clinical Specialist

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Locations

Showing 1 location

Hospital - Towson
Towson, MD 21204, USA

• On-site
• Salary Range : $67,999.78 USD to $108,576.83 USD
• Nursing
• Full-Time
• Requisition #: UTILI

Description

What to expect:

• Provides timely, comprehensive utilization reviews for behavioral health services for Sheppard Pratt patients.
• Conducts medical reviews for inpatient and partial hospitalization programs, maintains accurate documentation within hospital data systems, and communicates effectively with internal stakeholders and external agencies.
• Coordinates with Medicare, Medicaid, and Commercial Health Plans to ensure compliance with CMS (Centers for Medicare & Medicaid Services), Maryland Medicaid, and payer-specific requirements.
• Leads the appeals process through data-driven analysis, optimized workflows, and strengthened clinical documentation to support medical necessity decisions and successful appeal outcomes.

What you’ll get from Us:

At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:

• A commitment toprofessional development,includinga comprehensive tuition reimbursement program tosupport ongoing education and licensure and/or certification preparation
• Comprehensive medical, dental and vision benefitsfor benefit eligible positions
• 403b retirement match
• Generous paid-time-offfor benefit eligible positions
• Complimentary Employee Assistance Program (EAP)

Pay for this position is determined ona number offactors, including but not limited to,yearsand levelof related experience.

What we need from You:

• Associate or Bachelor’sdegree in nursing,Bachelor’s orMaster’sdegree inClinical Counseling,Healthcare Administration, or related clinical field.
• Active RN license, Licensed Clinical Professional Counselor(LCPC), or Licensed Certified Social Worker-Clinical (LCSW-C).
• Minimum of 3-5 years of experience inutilizationmanagement,orbehavioral health.
• Strong knowledge of payer requirements, clinicalcriteriaand behavioral health diagnosis.

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Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.