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Utilization Review Specialist

MALIBU GROUP LLC in Malibu, CA, USA

Employment Type

Full-Time

The UR staff is responsible for working directly with providers and facility staff to ensure coordinated, continuous coverage for current clients in treatment. UR specialists are tasked with advocating on the client’s behalf based upon medical necessity for appropriate care as needed.

  • Actively manages cases for clients admitted through all levels of care in the substance abuse and mental health settings.
  • Works with current UR team and facility contacts on case reviews for intake and concurrent authorizations looking for medical necessity and appropriateness of service and care.
  • Connects with members of the treatment team in the facility setting to coordinate the admissions/discharges, obtain clinical information, and answer questions concerning the necessity for utilization review.
  • Send provider updates to facility informing them of current authorization determinations.
  • Acts as a department resource for medical records requests within the company.
  • Depending on experience, may be asked to provide in service training to facility providers.

Ensure the privacy and security of PHI (Protected Health Information) as outlined in the established policies and procedures relating to HIPAA compliance.

QUALIFICATIONS

  • Possession of a valid State of California driver's license
  • 1 year of experience in UR setting is preferred but not required
  • Must be able to operate a general computer, fax, copier, and telephone
  • Must be knowledgeable of basic software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet
  • Knowledge of current EMR systems
  • Must possess proficient skills in English usage, grammar, and punctuation
  • Ability to follow instructions and respond to upper management directions accurately
  • Demonstrates thoroughness, effective communication skills, looks for ways to improve and promote quality and monitors own work to ensure appropriate quality is met
  • Must be able to work independently, prioritize work duties, and use time efficiently
  • Must be able to maintain confidentiality
  • Must be able to demonstrate and promote a positive team-oriented environment
  • Demonstrates reliability and abides by the company attendance policy
  • Must maintain a professional and clean appearance at all times consistent with company standards

Pay: Based upon experience.

About MALIBU GROUP LLC:

Malibu Group Billing is a boutique billing and insurance services company with gold standard customer service. We offer verification, utilization review and billing services for both medical and behavioral health professionals, practice groups and facilities.

Company address: 21235 Pacific Coast Highway, Malibu, CA 90265

Posted date: 8 days ago

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