About us

Serenity RCM focuses on Revenue Cycle Management services mental health and substance abuse facilities. We are looking to hire motivated individuals looking to join a growing company remotely. We are based out of NJ but the majority of our employees work remotely.

Job Summary

The Utilization Review Specialist performs all roles associated with Utilization Review, initial, concurrent, and retrospective. The UR Specialist recognizes the appropriate level of care and advocates for the patient using the ASAM criteria to obtain authorization.

Responsibilities and Duties

Provide utilization review for preauthorization, concurrent, discharge and post-service reviews using ASAM Criteria to determine authorization for the requested level of care
Collaborate with treatment team to discuss clinical authorization and quality of care.
Consistent and timely response to emails and other communications relating to utilization
review.
Communicates with facilities to obtain necessary documentation and clinical information.
Update billing software and EMR with authorizations.
Delegates tasks to Virtual Assistant in order to increase efficiency
Send written appeals for denied requests to insurers.
Other tasks or duties as assigned

Qualifications and Skills

Basic understanding of the Utilization review process
Familiar with the ASAM criteria and/or medical necessity criteria for each level of care (Detox, RTC, PHP, IOP, OP)
Effective communication skills, both verbal and written via phone and email
Proficiency with Microsoft Office products including Word, Excel, and Power Point
Knowledge in computers and can navigate various software programs

Education and Experience (Preferred but not required):

Associates and or Bachelor’s degree
** Experience with Substance Abuse industry, highly preferred but not required**

Benefits

Paid Time Off; Paid Holidays
40-hour work week or Part time
Positive work environment

Schedule: Monday to Friday

Work Location: Howell, NJ

Job Types: Part-time, Full-time

Salary: $40,000.00 - $55,000.00 per year

Benefits:

Paid time off

Schedule:

Monday to Friday

Work Location: Howell, NJ

Serenity RCM jobs

Utilization Review Specialist