UR Specialist

We are looking for a Behavioral Health Utilization Review Specialist to join Assembly Health. If you are looking for a company that is focused on being the best in the industry, love being challenged, and make a direct impact on our business, then look no further!  We are adding to our motivated team that pride themselves on being client-focused, biased to action, improving together, and insistent on excellence and integrity.  

This is a full-time, non-exempt position reporting to a UR Team Lead. The salary for this role starts at 60k. 

What You Will Do 

• Evaluate patient medical records to determine the necessity and appropriateness of services provided. 
• Analyze utilization data to identify trends, patterns, and opportunities for improvement. 
• Provide recommendations to improve efficiency and effectiveness of care delivery. 
• Manage utilization review schedule with providers and carriers 
• Communicate with behavioral health providers to obtain necessary information and clarify clinical details. 
• Communicate with insurance companies to resolve coverage issues and denials. 
• Collaborate with medical and administrative staff to ensure compliance with established protocols and guidelines. 
• Ensure that patient care meets regulatory requirements, accreditation standards, and payer requirements. 
• Conduct reviews in a timely manner for each patient 
• Stay updated on changes in regulations, standards, and guidelines affecting utilization review practices. 
• Obtain prior authorizations for services as required by insurance companies and other payers. 
• Monitor authorization periods and ensure timely renewals. 
• Maximize authorizations from insurance providers for all levels of care 
• Maintain accurate and detailed records of reviews, decisions, and communications.  
• Effectively report and resolve any issues that affect authorizations 
• Prepare and submit required reports to management, payers, and regulatory agencies. 
• Review and appeal denied claims or services as necessary, providing appropriate clinical information and documentation. 
• Attends UR meetings to discuss activities/needs of UR department 
• Execute additional duties as assigned, demonstrating diligence and meticulous attention to detail. 

What it Takes to Join the Family 

• Experience in healthcare, behavioral health (mental health, chemical dependency, or psychiatric nursing) preferred.   
• Minimum of one year experience in utilization review. 
• Comfortable working with common billing and EMR/EHR software 
• Familiar with both inpatient and outpatient levels of care (MH and SUD) 
• Knowledgeable of standard medical necessity criteria 
• Adherence to strict confidentiality standards to safeguard patient care information and protect patient rights. 
• Solid command of Microsoft Office applications, Google Suite, Adobe Acrobat, and other technologies 
• Strong attention to detail and accuracy in data entry and financial records maintenance. 
• Capability to manage multiple tasks and prioritize workload to meet deadlines. 
• Keen Attention to Detail, Dependable, accountable, quick learner 
• Exceptional interpersonal skills, organized, positive attitude, excellent verbal and written skills, excellent organizational skills, self-motivated and driven. 
• Complies with all performance measuring regarding pre-certification, concurrent reviews, and appeals. 
• Ability to function well in a fast-paced and at times stressful environment.  
• Prolonged periods of sitting at a desk and working at a computer. Ability to lift and carry items weighing up to 10 pounds at times.