Utilization Review Specialist - FT

We are Mental Health Treatment Centers of America (MHTCA), the parent company to mental health treatment facilities serving adults and teenagers with primary mental health disorders. We are in Fort Lauderdale, FL.

Come join us as we make a positive difference in the lives of others!

We seek an experienced Utilization Review (UR) Specialist to join our team!

Schedule:

UR Specialist - Monday - Friday 8:30a - 5:00p

The experienced UR Specialist should meet the following minimum requirements:

• Time Management skills and working within a fast-paced environment.
• Superior written and oral communication skills.
• Attention to detail to ensure necessary information is captured and properly documented.
• Ability to work independently and within a team.
• Ability to multi-task, prioritize and meet expected deadlines.
• Solid understanding of insurance benefits and coverages.

• Strong computer skills (Word, Excel, billing software).

• Understanding of mental and behavioral health treatment services.
  

• Knowledge of Ethics and Professional Standards.
• Excellent Interpersonal Skills and Boundaries.
• Knowledge of HIPPA, confidentiality and privacy practices.
• Knowledge of DCF Guidelines and Joint Commission Standards.
• Professionalism, organization, and customer focus.
• Ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
• 3-5 years of related experience in the behavioral health field, or an equivalent combination of education and experience.

Essential Job Functions:

• Review Client admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
• Obtain initial and continuing authorization for treatment services.
• Manage authorization denials including referral for peer review.
• Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment.
• Advocate on behalf of Clients to ensure maximum length of stay at the appropriate level of care.
• Interact with insurance companies in a respectful, professional manner that facilitates the utilization review process and follows policies and procedures.
• Document and record all necessary information.
• Monitor and track new and ongoing authorization cases.
• Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
• Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
• Participate in team meetings and case conference reviews.
• Maintain confidentiality of Client information and adhere to HIPAA regulations.

Job Status: Full-time

Pay: $65,000 - 75,000 per year

Medical Specialty: Psychiatry, Behavioral, Dual Diagnosis

Education: Associate's Degree (Preferred)

Experience: 3 years minimum (Required)

Work Location: In person

Ability to Commute: Lauderdale Lakes, FL 33319 (Required)

Benefits: We offer a competitive benefits package with voluntary and company-paid plans that demonstrate the commitment we have to our staff in providing the best benefit options that prioritize employee well-being. It includes:

• Comprehensive Health, Dental, and Vision insurance, ensuring you and your family have access to top-notch care
• Short-term and Long-term Disability
• Voluntary Life and AD&D insurance
• HSA and FSA accounts
• Worksite benefits - Accident, Hospital Indemnity and Critical Illness plans
• Legal plan
• Corporate discounts
• Employee assistance program
• Pet insurance
• Enjoy a healthy work-life balance with ample time off so you can recharge and take care of personal matters, which includes: 7 holidays, vacation, sick and personal time-off.
• 401(k) w/ match with eligibility after completion of 90 days employment to invest in your future and help you build financial security for tomorrow.
• We believe in your growth! We have professional development opportunities, that include our ongoing compliance training program, to advance your skills and career.

We encourage all qualified candidates to apply with confidence and will contact all candidates that closely match the position requirements. We wish all candidates the best of luck in your search!

8:30a - 5:00p onsite