What are the responsibilities and job description for the Utilization review specialist position at Catholic Charities Diocese of Trenton?
JOB SUMMARY :
- Responsible for requesting and obtaining prior authorizations for treatment services from several treatment modalities within the agency in a timely manner to ensure no gaps in care or coverage.
- Authorizations are to be obtained from entities inclusive of but not limited to pay sources : Medicaid, Managed Care Organizations, NJSAMS, Commercial Insurance, etc.
- Responsible for managing and tracking prior authorization approvals and requests for all enrolled consumers.
- Coordinating with program leadership and staff to ensure clinical documentation (Progress notes, Treatment Plans, are completed in a timely manner and contains sufficient clinical content to support prior authorization services.
ESSENTIAL FUNCTIONS :
1. Verifying insurance(s)
2. Obtaining authorizations from insurance companies for services to be provided
3. Work with clinical team to appeal authorization denials
4. Maintain spreadsheet that tracks all pertinent data of the authorization
5. Building and maintaining professional relationships with treatment providers and insurance company representatives.
6. Collaborating with the treatment team to review service needs
7. Ensuring that there is clear communication between team members, insurance company representatives and consumers
8. Other duties as assigned by supervisor and Agency Leadership
KNOWLEDGE / SKILLS / ABILITES :
Preferred skills :
- Knowledgeable about behavioral health services including ambulatory services such as Outpatient, Partial Care, and Addictions treatment.
- Knowledgeable about healthcare claims and processing including prior authorizations, CPT codes, MCOs, Medicaid, etc..
- Proficient in use of technology, various applications including Microsoft Office (including Excel), Electronic Health Records, and other databases such as NJSAMs, eMevs and Navinet.
- Strong skills related to clinical documentation
- Excellent written and verbal communication, as well as interpersonal skills.
- Ability to multi-task and handle various responsibilities / duties / issues simultaneously while meeting timelines.
- Detail and problem solving orientated.
SUPERVISORY REQUIREMENTS : NO
Position Requirements
MINIMUM QUALIFICATIONS : High School Diploma
PREFERRED :
- Bachelor's degree from an accredited college or university in human services, psychology, social work discipline.
- Utilization Review experience
LICENSES / CERTIFICATIONS NEEDED : Valid Driver’s License
Exempt / Non-Exempt Exempt Weekly Work Hours 40 Proposed Salary $48,000 / annually ScheduleMonday to Friday 8 : 00 AM to 4 : 30 PM
This position is currently accepting applications.
Last updated : 2024-11-14
Salary : $48,000
