Utilization Review Specialist

The Utilization Review Specialist at Premier Health Group ensures that services provided to clients are authorized by insurance companies, playing a critical role in securing payment for services. This position involves obtaining and tracking authorizations, ensuring timely communication with payers, and collaborating with clinical teams to align with payer requirements.What's in it for You?Medical, Dental, and Vision Insurance 401(k) with 4% MatchingPaid Time Off (PTO)Free ParkingKey Responsibilities:Obtain and manage authorizations for all levels of care, ensuring timely submissions to insurance carriers.Work with clinical teams to ensure accurate documentation is submitted for continued care approvals.Address and resolve authorization denials by coordinating appeals with clinical staff and payers.Maintain accurate and up-to-date records of authorizations, approvals, and denials for auditing and billing purposes.Serve as the liaison between the facility and insurance companies to address authorization-related issues.Qualifications:Bachelor’s degree in nursing, social work, psychology, or a related field preferred.Minimum of 2 years of experience in utilization review, case management, or similar roles.Strong knowledge of insurance authorization processes and payer requirements.Excellent communication and organizational skills.

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