Utilization Review Specialist - Finance at RiverValley Consulting Services – Owensboro, Kentucky

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.

Essential Functions:

• Verifies insurance benefits and relays that information to appropriate parties.
• Participates in skill enhancement activities.
• Participants 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.

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.