Utilization Review Specialist

🕒 Julho 22

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Bradford Health Services

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1977

🏥 Saúde

🧘 Bem-estar

🤝 Sem Fins Lucrativos

Healthcare • Wellness • Non-profit

A Bradford Health Services é um provedor líder de programas de tratamento para dependência, oferecendo uma ampla gama de serviços para apoiar indivíduos em sua jornada de recuperação. Com instalações em todo o Sudeste, eles fornecem reabilitação interna e ambulatorial, serviços de desintoxicação e diversos programas especializados adaptados para atender às necessidades únicas de seus pacientes. Seu compromisso com o tratamento acessível e baseado em evidências garante que os indivíduos possam acessar o apoio necessário para recuperar suas vidas da dependência.

Descrição

• Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services. • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details. • Make informed decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements. • Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards. • Stay current with evolving healthcare regulations, payer policies, and clinical best practices to ensure consistent and compliant review processes.

🎯 Requisitos

• Bachelor’s degree in Nursing, Health Administration, or a related healthcare field. • At least 2 years of experience in utilization review, case management, or clinical healthcare roles. • Strong knowledge of medical terminology, clinical procedures, and healthcare regulations. • Familiarity with insurance authorization processes and healthcare reimbursement models. • Excellent analytical, communication, and organizational skills. • Registered Nurse (RN) license or equivalent clinical certification (preferred). • Experience with electronic health records (EHR) systems and utilization management software (preferred). • Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager) (preferred). • Advanced knowledge of Medicare, Medicaid, and other payer-specific guidelines (preferred).

🏖️ Benefícios

• Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits. • Expanded Coverage – Options for domestic partners and a wider network of in-network providers. • Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching. • Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more. • Student Loan Repayment – Available for nurses and therapists. • Retirement Benefits – 401(k) plan through Voya to help employees plan for the future. • Generous PTO – A robust paid time off policy to support work-life balance. • Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.