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Utilization Review Specialist - PHP

Company: VirtualVocations
Location: Arlington
Posted on: November 8, 2024

Job Description:

A company is looking for a Utilization Review Specialist for a Partial Hospitalization Program (Remote).



Key Responsibilities

Conduct comprehensive reviews of patient records to ensure appropriate service utilization and compliance with insurance requirements
Collaborate with clinical teams, insurance companies, and billing departments to facilitate transitions of care and ensure accurate documentation
Promote quality patient outcomes while managing resource efficiency


Required Qualifications, Training, and Education

Bachelor's degree in nursing, social work, or a related healthcare field required; licensure preferred (e.g., RN, LCSW, LMFT)
Master level clinician (MSN, MSW, etc.) preferred
Minimum of 2 years' experience in a behavioral health setting, preferably in utilization review or partial hospitalization programs
Strong knowledge of payer regulations and medical necessity criteria
Experience in utilization management processes is preferred

Keywords: VirtualVocations, Silver Spring , Utilization Review Specialist - PHP, IT / Software / Systems , Arlington, Maryland

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