Utilization Review (UR) Specialist

Job Details
Job Location
Ridgeview Institute Smyrna - Smyrna, GA
Position Type
Full Time
Education Level
4 Year Degree
Salary Range
$20.00 - $27.00 Hourly
Job Shift
Day
Job Category
Health Care
Description
JOIN OUR TEAM AS A UR SPECIALIST !
We are growing our team!
Utilization review specialists assess patient care plans and determine what treatment is appropriate and most cost-effective. They investigate disputed medical claims, coordinate utilization training for the medical staff, analyze electronic medical records, and inform them whether a medical claim is denied, approved, under review, or appealed. The utilization review specialist often advocates for quality patient care, cost reduction, and hospital quality standards.
Summary of Duties:

1. Review the treatment plan and advocate for additional services as indicated.
2. Maintain ongoing contact with the attending physician, program manager, nurse manager, and various team members.
3. Collaborate with the treatment team regarding continued stay and discharge planning issues.
4. Advocate for the patient to be placed in the appropriate level of care and program.
5. Interface with program staff to facilitate a smooth transition during transfer or discharge.
6. Assure tracking of insurance reviews and that reviews are completed on time.
7. Maintain statistical reports and prepare documentation of significant findings.
8. Update the denial log statistics on an ongoing basis (at least weekly), and initiate appeals through telephone or written communication within 7 to 10 days of denial.
9. Consult with the business office and/or admission staff to clarify data and ensure the insurance precertification process is complete.
10. Provide clinical information to managed care companies, insurance companies, and other third-party reviewers to establish the length of stay or number of certified days.
11. Coordinate with the insurance company doctor in appeals process and denials process.
12. Research and prepare reports to identify claims-related trends and high-level reimbursement issues.
13. Appeal denied claims and underpaid claims and associated follow-up with insurers.
14. Outstanding organizational skills, with the ability to multitask.

*The essential job functions of this position are not limited to the duties listed above.
Your Experience Matters What we're looking for:
Education: Bachelor's or Master's degree from an accredited college or university in social work, mental health, nursing, or related degree preferred; BSN preferred.
Experience: A minimum of two (2) years of related experience, in a helathcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management, preferred.
Licensure: Must maintain a valid driver's license in the applicable state. LMSW/RN preferred.
Additional Requirements: Successful completion CPR/ First Aid certification and CPI training to within 90 days of employment prior to assisting with restraining procedures. May be required to work overtime and flexible hours.
KNOWLEDGE, SKILLS, AND ABILITIES:
1. Knowledge of case management techniques.
2. Knowledge of patient assessment and treatment planning techniques.
3. Knowledge of external review organizations (i.e. managed care, Medicare, Medicaid, etc.).
4. Excellent leadership and negotiation skills.
5. Excellent customer relations skills.
6. Excellent organizational and interpersonal communication skills.
7. Ability to communicate effectively both verbally and in writing.
8. Ability to handle conflicting situations.
9. Ability to focus on details in a busy environment.
10. Ability to work at a rapid pace in a fast-paced environment.
Your Care Matters What we provide for our team:

• 401(k) + matching
• Health insurance
• 100% company-paid life insurance coverage up to 2x your annual salary
• Vision insurance
• Dental insurance
• 100% company-paid long term disability insurance
• Paid time off
• Paid Holidays
• Cafeteria on site + one free meal per day
• Employee engagement events
• Employee assistance program
• Employee recognition program
• Free parking

What sets us apart:

• Career & training development opportunities
• Dynamic and inclusive work environment
• Engaged management team dedicated to your success
• A guiding mission and set of values that serve as both our north star and yours, anchoring our collective purpose and aspirations

Disclaimer: Benefits are subject to change at the discretion of Ridgeview Institute Smyrna.
Compensation:
This is a full-time role, non-exempt and the expected compensation range is $18.00 to $25.00/hour. We're eager to engage with all qualified candidates, and consideration will be provided to experience and skill level. Join us as our UR SPECIALIST !
About us
Get to know us Outstanding Care, Compassionate People, Unparalleled Service
Welcome to Ridgeview Institute Smyrna (RIS), a premier healthcare provider in Smyrna, GA, setting the gold standard for excellence in mental health and addiction treatment support. Located in Smyrna, GA, RIS offers a full continuum of care, including inpatient and outpatient psychiatric services and specialized, evidence-based programs for all patients, regardless of their ability to pay.
At RIS, the community is an integral part of our team, fostering collaboration to build an efficient, comprehensive, and seamless continuum of care. We take pride in offering dynamic, challenging, and highly rewarding positions. You'll have the opportunity to work closely with a team of experts, ensuring our patients receive personalized services that guide them toward achieving their treatment goals.
Join us in providing exceptional care and contributing to the well-being of individuals and families in need, and be a part of the transformative healthcare experience at Ridgeview Institute Smyrna.
To learn more about RIS, visit us at:
TOGETHER WE CAN MAKE POSITIVE I.M.P.A.C.T.S.
Individuals Maintaining Positive Attitude and Commitment To Service
At Ridgeview Institute Smyrna, we value a diverse, inclusive workforce and provide equal employment opportunities for all applicants and employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.