THE RESEARCH INSTITUTE AT NATIONWIDE CHILDRENS HOSPITAL
Utilization Review Specialist - Autism
Main Campus, Columbus, OH
Sponsorship not specifiedDetected 5 hours ago
Customer SupportCommunicationProblem Solving
About the role
- Position is work from home after a 90 day in-office training period.
- Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies.
- Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Responsibilities
- Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
- Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management.
Requirements
- Bachelor's Degree in Social Work, Psychology, or related field, required.
Skills
- Excellent written and verbal communication and interpersonal skills.
- Excellent customer service and organizational skills.
- Working knowledge of CMS and other review agency standards.
- Proficient with software applications including CM, payer web applications, MITS, and others.
- Three years of behavioral health experience, required.
- One year of experience in pediatric care or services, required.
- Utilization review or utilization management experience, preferred.
Benefits
- Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
- Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
- Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
- Provides education and support regarding utilization review and management activities and processes.
- Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
- Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.
Apply directly at THE RESEARCH INSTITUTE AT NATIONWIDE CHILDRENS HOSPITAL →Create a free account for alerts like thisView THE RESEARCH INSTITUTE AT NATIONWIDE CHILDRENS HOSPITAL immigration profile
This listing is sourced directly from THE RESEARCH INSTITUTE AT NATIONWIDE CHILDRENS HOSPITAL's careers page and normalized into a canonical job model.