Utilization Review Specialist - Newport Healthcare

Newport Healthcare is a nationwide behavioral healthcare organization dedicated to transforming young lives through evidence-based care. To that end, we have assembled the best teen and young adult mental health treatment staff in the country, and we want you to join us. While our experts guide our clients to sustainable healing, our job is to support our valued staff members, and we do that through offering industry-competitive salaries, career growth and skills expansion, student loan repayment and tuition reimbursement, and a company commitment to diversity, equity, and inclusion, among other advantages. Be part of a team that's dedicated to providing compassionate care based in authentic connection, mutual respect, and unconditional love—and experience the rewards of making a difference in the lives of young people and their families each and every day.

Empowering Lives. Restoring Families.®

Responsibilities:

The Utilization Review Specialist is responsible for managing an active caseload of clients at the following Levels of Care: Detox, Residential, Partial Hospitalization, and Intensive Outpatient. They act a liaison between insurance companies, the client, the client’s family, and the Clinical Team and are responsible for communicating updates to appropriate representatives at the insurance company, the Clinical Team, and the client’s family as directed by the Manager/Director of Utilization Review. They are responsible for gathering required information, effectively case-building, and collaborating consistently with members of both the Utilization Review Team and interdisciplinary Treatment Team to ensure optimization of each client’s coverage and benefits.

Essential Duties:

• Coordinate, schedule, and complete Initial, concurrent, Peer, and retrospective reviews in a timely manner to ensure continuous coverage, per use of clinical information and knowledge of Medical Necessity criteria, to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
• ‪Conduct and manage initial, concurrent, and discharge reviews to optimize benefits and utilization while representing the UR Department in a professional and positive way to other Departments and the company as a whole.
• Maintain contact with the clients’ families and keep them updated on current insurance authorization updates, Peer Reviews, and Denials.
• Document all activities in a detailed manner in applicable CRM/EMR.
• ‪Collaborate with Clinicians and the multidisciplinary team daily at both the Residential and Day Programs in order to obtain necessary clinical documentation for reviews and ensure effective utilization of resources.
• ‪Participate in weekly Treatment Team and Continuing Care Meetings as appropriate.
• ‪Prepare and submit Appeal documentation (including rationales) to the appropriate entities as indicated.
• Complete weekly Treatment Team notes and provide updates to the Psychiatrist as requested by the Director/Manager.
• Follow chain of command both within the Department and outside of the Department.

• At least two (2) years of work experience in the behavioral health field.
• Active license or credential in a behavioral health field preferred.
• Bachelor’s or Master’s in a behavioral health related specialty preferred.

Newport Healthcare is an Equal Opportunity Employer.

Newport Healthcare provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, genetic information, or any other characteristic protected by federal, state, or local laws.

Newport Healthcare is committed to ensuring equal employment opportunity, including providing reasonable accommodations to individuals with a disability.  Applicants with a physical or mental disability who require a reasonable accommodation for any part of the application or hiring process please email accommodations@newportacademy.com for assistance.

For more information on Equal Opportunity, please click here Equal Employment Opportunity Posters