UR SpecialistShift: M-Fr 8-5This is not a remote position. It is an office-based position in Cincinnati, Ohio.At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.The Role ItselfPosition Summary: The Utilization Review Specialist is responsible for the authorizations and certifications process for Inpatient and Outpatient Services.
This includes the precertification and recertification process, peer to peer reviews, and appeal. The UR Specialist will accurately report the authorization status of patients, denials and appeals status to the Corporate Director of UR. The UR Specialist will follow department and department procedures and ensure effective communication with all relevant departments regarding patient care needs.Job ResponsibilitiesAs Utilization Review Specialist, you will :Obtain Continued Stay Reviews for Inpatient and Outpatient behavioral health treatment.Follow up on prior authorization submissions that need further information to obtain authorization.Display knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization, and advocates on behalf of the patient to secure coverage for needed services.Strong working knowledge of external review organizations (ie: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.Report appropriate denial and authorization information to designated resource.Coordinate authorization information with third party payors in a timely manner.Complete thorough and accurate documentation in all required systems.Maintain communication system based on documentation and verbal exchange regarding treatment with other UM staff and staff at the facilities as needed.Schedule and follow up on results of Peer to Peer requests for physicians and CNP.Maintain Denial LogEducationHigh school diploma or GED (Required), Bachelor's Degree or Master's Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field preferred.Previous Utilization Review experience in a behavioral healthcare facility preferred.License : LPN, RN, LSW, LPC, LCDC or applicable license preferredSkillsAbility to multi-taskStrong organization skillsStrong problem-solving skillsAbility to work well independently and as part of a teamPerks at WorkHealthcare :Medical Packages with Rx – 3 ChoicesFlexible Spending Accounts (FSA)Dependent Day Care Spending AccountsHealth Spending Accounts (HSA) with a company matchDental Care Program – 2 choicesVision PlanLife Insurance OptionsAccidental InsurancesPaid Time Off + Paid HolidaysEmployee Assistance Programs401k with a Company MatchEducation + Leadership Development :Up to $15,000 in Tuition ReimbursementsStudent Loan Forgiveness ProgramsOur overall mission is to Inspire Hope, Restore Peace of Mind and Heal Lives.