Utilization Review Specialist

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🕒 July 22

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Cornerstone of Recovery

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1989

🏥 Healthcare

🧘 Wellness

🌍 Social Impact

Healthcare • Wellness • Social Impact

Cornerstone of Recovery is an addiction treatment facility located near Knoxville, TN, dedicated to helping individuals overcome drug and alcohol addiction. Offering comprehensive residential and outpatient rehab programs, Cornerstone aims to provide effective and affordable care through a compassionate team of medical and recovery support professionals. With a focus on personalized treatment, Cornerstone has been serving those in need since 1989 and is committed to fostering hope and healing in a supportive community environment.

📋 Description

• 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.

🎯 Requirements

• 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. • Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification. • Experience with electronic health records (EHR) systems and utilization management software. • Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager). • Prior experience working with managed care organizations or insurance companies. • Advanced knowledge of Medicare, Medicaid, and other payer-specific guidelines.

🏖️ Benefits

• 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.