Become an Assembler! We are looking for a 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 the U/R Manager.

What you'll 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 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 we're looking for

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.

Why join the team?

Be part of something special! We are growing both organically and through acquisitions.
Career growth - your next role with Assembly might not be created yet and we are waiting for your help to chart the way!
Ongoing training and development programs.
An environment that values transparency
Competitive Benefit Packages available, Paid Holidays, and Paid Time Off to enjoy your time away from the office.

Assembly Health jobs

Utilization Review Specialist