Utilization Review Specialist - PHP
Company: VirtualVocations
Location: Dayton
Posted on: November 1, 2024
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Job Description:
A company is looking for a Utilization Review Specialist for a
Partial Hospitalization Program (Remote).
Key Responsibilities
Conduct comprehensive reviews of patient records to ensure
appropriate service utilization and compliance with insurance
requirements
Collaborate with clinical teams, insurance companies, and billing
departments to facilitate transitions of care and ensure accurate
documentation
Promote quality patient outcomes while managing resource
efficiency
Required Qualifications, Training, and Education
Bachelor's degree in nursing, social work, or a related healthcare
field required; licensure preferred (e.g., RN, LCSW, LMFT)
Master level clinician (MSN, MSW, etc.) preferred
Minimum of 2 years' experience in a behavioral health setting,
preferably in utilization review or partial hospitalization
programs
Strong knowledge of payer regulations and medical necessity
criteria
Experience in utilization management processes is preferred
Keywords: VirtualVocations, Hamilton , Utilization Review Specialist - PHP, IT / Software / Systems , Dayton, Ohio
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