Utilization Review Specialist

Full Time
Irvine, CA 92612
Posted
Job description
About Us:
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 Pre-Certification Specialist is responsible for the pre-certification process for prospective clients. Working in conjunction with the Admissions Coordinators and Management, the Pre-Certification Specialist’s primary goal is to obtain initial authorizations for treatment in as efficient a manner as possible.

Essential Duties:
  • Complete pre-certifications for clients admitting to any of Newport Healthcare’s programs.
  • Utilize clinical information and knowledge of Medical Necessity insurance case managers, facility staff, and plans of care to rationale and communicate healthcare partners.
  • Communicate authorization status to families, Admissions Department, Facility Staff, and other stakeholders as needed.
  • Document all activities in a detailed manner in applicable CRM/EMR.
  • Prepare and submit Appeal documentation (including rationales) to the appropriate entities as indicated.
  • Coordinate, schedule, and complete Peer-to-Peer and Appeal reviews as they relate to the precertification process.
  • Responsible for coverage of concurrent reviews or administrative tasks, if needed based on business needs.
  • Perform periodic reporting on data surrounding pre-authorizations, if needed based on business needs.
Qualifications:
  • At least two (2) years of work experience in the behavioral health field required.
  • Credential in a behavioral health field preferred.
  • Bachelor’s/Master’s in a behavioral health related specialty preferred.

Salary Range for this position based on Education and Experience:
$25.00 - $34.00/hr


Benefits include:

Medical/Dental/Vision

Company Paid Life Insurance

Volunatary STD/LTD

Flexible Spending Accounts


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

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