Utilization Review Specialist at Walker Health Services, LLC – Pikesville, Maryland
Walker Health Services, LLC
Pikesville, Maryland, 21208, United States
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About This Position
Walker Health Services
Job Title: Utilization Review Specialist
Job Summary:
Walker Health Services is seeking a highly skilled and detail-oriented Utilization Review Specialist to join our team. This individual will be responsible for reviewing patient admissions and clinical information to ensure medical necessity and compliance with utilization review guidelines. The role involves managing authorization processes, advocating for patients, and collaborating with clinical staff and insurance companies to facilitate the utilization review process.
Walker Health Services is seeking a highly skilled and detail-oriented Utilization Review Specialist to join our team. This individual will be responsible for reviewing patient admissions and clinical information to ensure medical necessity and compliance with utilization review guidelines. The role involves managing authorization processes, advocating for patients, and collaborating with clinical staff and insurance companies to facilitate the utilization review process.
Key Responsibilities:
- Review patient admission and clinical information to ensure medical necessity and compliance with state-specific utilization review guidelines.
- Obtain initial and continuing authorization for treatment services.
- Use electronic medical records systems (e.g., Kipu EMR, Alleva) to manage patient data, billing information, and claims processing.
- Manage authorization denials, including referrals for peer reviews.
- Advocate on behalf of patients to ensure the maximum length of stay at the appropriate level of care.
- Interact with insurance companies in a respectful and professional manner, adhering to policies and procedures.
- Document and record all necessary information related to patient care and authorization processes.
- Monitor and track new and ongoing authorization cases.
- Collaborate with clinical staff to ensure that necessary information is obtained and timely reviews are performed.
- Assist the treatment team in understanding payer requirements for admission, continued stay, and discharge planning.
- Participate in team meetings and case conference reviews.
- Maintain confidentiality of patient information in compliance with HIPAA regulations.
- Perform other related duties as necessary to meet the organization’s ongoing needs.
Requirements:
- 3-5 years of experience in Substance Abuse and/or Mental Health.
- Understanding of mental and behavioral health treatment services.
- Understanding of insurance benefits and coverages.
- Excellent attention to detail to ensure all necessary information is captured and properly documented.
- Ability to work independently and within a team environment.
- Ability to multi-task, prioritize, and meet expected deadlines.
- Strong computer skills, including proficiency with Word, Excel, and billing software.
- Superior written and oral communication skills.
Additional Information:
This job description is intended to provide a general overview of the responsibilities and requirements for the role. The employee may be required to perform other related duties as necessary to meet the organization’s ongoing needs.
This job description is intended to provide a general overview of the responsibilities and requirements for the role. The employee may be required to perform other related duties as necessary to meet the organization’s ongoing needs.
How to Apply:
If you meet the qualifications and are seeking a great opportunity in the field of utilization review, Walker Health Services encourages you to apply. Please submit your resume and a cover letter detailing your relevant experience.
If you meet the qualifications and are seeking a great opportunity in the field of utilization review, Walker Health Services encourages you to apply. Please submit your resume and a cover letter detailing your relevant experience.
Job Type: Full-time
Location Requirements:
- Must be able to commute to Pikesville, MD 21208 (Required).
Work Location: Hybrid
Salary: $65,000 - $75,000
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Job Location
Pikesville, Maryland, 21208, United States
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