Utilization Review Specialist

Job not on LinkedIn

🔥 2 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $60k - $66.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Gosnold Behavioral Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1972

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Gosnold Behavioral Health is a nationally accredited, non-profit 501(c)(3) provider of comprehensive behavioral health and substance use disorder services based in Massachusetts. For 50 years it has offered an end-to-end continuum of care including inpatient medical detoxification and clinical stabilization, women's residential treatment, partial hospitalization (PHP), intensive outpatient (IOP), outpatient counseling, medication-assisted treatment (MAT), telepsychiatry, recovery coaching, overdose outreach, emergency department navigation, veteran and school-based programs, and community support services. Gosnold emphasizes individualized, patient-centered treatment, prevention and recovery supports, partnerships with law enforcement and healthcare systems, and relies on donations to support its mission.

📋 Description

• Perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies • Communicate daily with Patient Financial Services to ensure patient coverage • Consult with clinical staff to coordinate intervention strategies and authorizations for continued care • Provide technical assistance to staff with care coordination activities • Prepare and present cases for physicians for doctor-to-doctor reviews • Document and record authorizations and utilization review results in the computer system • Record and report progress and expectations for the next utilization review to treatment teams • Educate treatment teams about member insurance benefits and support comprehensive aftercare coordination • Provide managed care providers with information about alternative levels of care within the Gosnold system • Perform other assigned duties

🎯 Requirements

• Bachelor’s degree in nursing, social work, psychology, mental health or addiction required • At least 2 years of clinical experience in delivery of health services • Experience in performing utilization review and/or providing clinical services in an intensive treatment setting preferred • Knowledge of clinical criteria required for various levels of care • Computer literacy and ability to learn and use behavioral health software programs • Good communication, interpersonal, and organizational skills

🏖️ Benefits

• Blue Cross & Blue Shield health and dental insurance • Vision insurance • Medical and dependent care flexible spending accounts • Generous paid vacation, sick, and holiday time • 403b retirement savings plan with employer match • Personal financial management services • Life and supplemental life insurance • Critical illness and accident insurance • Employee Assistance Program • Pet insurance • Tuition assistance

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume