We are a reputable third party billing company that specializes handling behavioral health companies' RCM around the country. The Utilization Review Specialist is responsible for utilization management for both incoming clients as well as current clients. We are looking experienced candidates who are willing to work hard. We have an office space in Southeast FL but are willing to consider remote candidates as well.

Responsibilities/Qualifications:

1. Complete assessments and pre-certifications

2. Complete utilization, discharge and peer reviews

3. Initiate and resolve appeals

4. Ensure EMR is up to date and accurate in regards to UR

5. Work closely with clinical team to ensure continuity and quality of care for clients

6. Utilize ASAM criteria to identify and advocate for appropriate level of care placement

7. Monitor clinical documentation to insure appropriate, timely and effective provision of services and treatment planning

8. Ensure that all insurance information needed for billing and collection processes are obtained and recorded appropriately in the EMR system

9. Maintain confidentiality pertaining to clients and families.

10. Any other duties as instructed by management.

11. Acquire and maintain all CEU, CPR, trainings, etc. as required by DCF and JCAHO.

Required:

· Bachelor’s Degree

· 2 years minimum in the substance abuse and/or mental health industry

OON insurance experience

· Extensive knowledge of utilization management and the processes.

· Knowledge of chemical dependency and behaviors.

· Demonstrates proficiency in communication & written skills.

Job Type: Full-time

Pay: $60,000.00 - $80,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Schedule:

Monday to Friday

Education:

Bachelor's (Preferred)

Experience:

substance use/mental health industry: 2 years (Required)
out of network insurance: 1 year (Required)
Utilization review: 1 year (Required)

Location:

Florida (Required)

Work Location: Remote

Prosperity Behavioral Healthcare Consulting LLC

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Utilization Review Specialist