Utilization Review Specialist
RIVER VALLEY BEHAVIORAL HEALTH
Summary
The Utilization Review Support Specialist is responsible for assuring insurance coverage of clients for treatment, by obtaining pre-certification and authorizations for various levels of care from insurance companies (the payers). The pre-certification and authorizations of coverage are obtained by demonstrating medical necessity through the presentation of medical and clinical documentation meeting applicable criteria guidelines. Collaborate with programs and departments in coordinating the UR process.
Job description
Essential Functions
- Verifies insurance benefits and relays that information to appropriate parties.
- Participates in skill enhancement activities.
- Participates in treatment team meetings when necessary.
- Provides data and reports to UR supervisor as requested.
- Provides backup for the UR Specialist or other UR staff as needed.
- Fosters collaborative working relationships among members of the UR team, programs providing UR services for, and management teams.
- Other duties as assigned by UR Supervisor.
Qualifications: Education and Experience
- High School/GED AND Two (2) years' experience working in mental health utilization review (or equivalent)
- OR Bachelor's Degree in human services-related field (Psychology, Social Work, Sociology)
- OR KY LPN/RN License
Knowledge and Skills
- Good knowledge of general office practices.
- Ability to deal effectively with the public.
- Good organizational skills.
- Basic computer skills preferred.
Requirements
- High School/GED AND Two (2) years' experience working in mental health utilization review (or equivalent)
- OR Bachelor's Degree in human services-related field (Psychology, Social Work, Sociology)
- OR KY LPN/RN License
- Good knowledge of general office practices
- Ability to deal effectively with the public
- Good organizational skills
- Basic computer skills preferred
Benefits
- Competitive pay
- Medical, Dental & Vision
- Telehealth Benefits
- Paid Time Off
- 9 Paid Holidays
- Retirement Plan Options
- Tuition Reimbursement
- Free CEUs
- Clinical Supervision
- Professional Development
- Wellness Programs
- Employee Assistance Programs
- Mileage Reimbursement
- Public Service Loan Forgiveness
Company overview
River Valley Behavioral Health is a comprehensive mental health care provider specializing in behavioral health services for individuals and communities. As a healthcare provider organization, it focuses on delivering evidence-based treatment and support services for mental health conditions, substance use disorders, and developmental disabilities. The organization typically offers a range of services including outpatient counseling, crisis intervention, psychiatric care, addiction treatment, and community-based support programs. River Valley Behavioral Health serves as a critical resource in its region, providing accessible mental health care to diverse populations through integrated treatment approaches. The organization emphasizes person-centered care, recovery-oriented services, and community partnerships to address the complex needs of individuals facing behavioral health challenges. With a commitment to improving mental wellness and quality of life, River Valley Behavioral Health plays an essential role in the healthcare ecosystem by bridging gaps in mental health services and promoting holistic well-being for the communities it serves.