Utilization Management Specialist

Job not on LinkedIn

🔥 23 hours ago

🇺🇸 United States – Remote

💵 $31 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Paradigm Treatment

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

👥 B2C

💰 Private equity on 2019-04

Healthcare • B2C

Paradigm Treatment is a provider of residential mental health treatment programs for teens, young adults, and adults operating multiple campuses in the U. S. The organization offers clinically intensive, evidence-based residential care (average stays 30–90 days) that integrates individual and family therapy, group therapy, psychiatric care, academic support, nutrition, and recreational therapies. Paradigm treats a wide range of mental health and co-occurring substance use conditions — including anxiety, depression, PTSD/trauma, bipolar disorder, personality disorders, OCD, self-harm, and technology/social media addictions — and emphasizes individualized, family-inclusive treatment plans. They accept many major commercial insurers, provide insurance verification, and are part of the Altior Healthcare family.

📋 Description

• Direct and oversee the reporting of utilization statistics and trends. • Consult with all services to ensure the provision of an effective treatment plan for all patients. • Interface with managed care organizations, external reviewers, and other payers. • Advise the clinical team on documentation necessary to advocate for admission and continued stay at the most appropriate level of care. • Utilize clinical information and Behavioral & Mental Health Medical Necessity criteria to communicate plans of care to insurance case managers, facility staff, and healthcare partners. • Collaborate with Admissions and Billing to support and improve the commercial insurance authorization process. • Maintain logs and databases for utilization management, fiscal management, care coordination activities, and performance improvement measures. • Conduct prospective, concurrent, and retrospective reviews using telephonic information, medical records, and/or faxed medical information; establish single cases as necessary.

🎯 Requirements

• Previous experience with Utilization Review. • Previous experience within the field of mental health or behavioral health.

🏖️ Benefits

• Comprehensive benefits package: medical, dental, and vision. • 401k with 4% match. • Paid Time Off Programs including vacation, holidays, and illness.