Branch Review Specialist jobs in Raleigh, NC

Overview

Triangle Springs Springs

*Fully In-Person Role*

Part-Time Utilization Review Specialist

Members of our team Enjoy:

• Working with a highly engaged staff
• Healthy staffing levels
• Flexible scheduling
• Career growth
• Competitive compensation
• Health, Vision, Dental, 401k, and Paid Time Off

• UKG Wallet – We’ve partnered with UKG Wallet, a voluntary Earned Wage Access benefit, to offer employees access to their pay on their own schedule.

Triangle Springs is a 77-bed behavioral hospital located in Raleigh, NC. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Triangle Springs we are dedicated to Changing People’s Lives®

The Utilization Review department plays an essential role in helping fulfill our mission of “Changing People’s Lives®”.  Utilization Review team members advocate on behalf of our patients to managed care providers for necessary treatment.  As a Utilization Review Specialist, you will accurately and timely complete utilization review activities.

Position Details

• Acts as a liaison between managed care organizations and the facility’s behavioral health clinical treatment team.
• Conducts clinical reviews in accordance with certification requirements of insurance plans or other managed care organizations.
• Monitors patient length of stay and conducts initial and concurrent reviews when indicated to provide clinical information needed to support medical necessity criteria for appropriate level of care.
• Facilitates peer to peer reviews between the facility treatment provider and the managed care physician.
• Assists the Assessment Department with completion of the precertification process for admissions.
• Provides ongoing support and training for staff on documentation requirements, admission and continued stay criteria, and medical necessity updates.

Qualifications

Qualifications:

• Knowledge of mental health and chemical dependency terminology, symptoms, diagnoses, and treatment.
• Ability to communicate effectively with patients, internal and external treatment providers, and managed care clinical review care managers.
• Ability to multi-task, pay attention to detail, problem solve, utilize critical thinking skills, prioritize, and work both independently and as a part of a team.
• Strong computer skills and ability to navigate electronic systems applicable to job functions.

Requirements:

• Bachelor’s degree or current clinical license required in lieu of degree
• CPR and CPI Certification within 30 days of employment

Experience:

• Previous utilization review experience in a psychiatric healthcare facility preferredEducation and experience in the field(s) of: Social Work, Psychology, Psychiatric Nursing, Marriage and Family and Child Counseling, Chemical Dependency Counseling, Registered Nursing or a closely related science field