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Utlization Review Specialist
Segoso
- Hanover / St. James / Trelawny
- Not disclosed
- Permanent full-time
- Updated 17/06/2025
- HRM
The Utilization Review Specialists works on behalf of Behavioral Health facilities assessing patient care plans ensuring its appropriateness to ascertain cost effective treatments, acting as a contact between the facility/provider and insurance carriers.
Primary duties may include but not limited to:
- Reviewing Medical Necessity
- Authorizations and Approvals
- Level of Care Determination
- Concurrent and Retrospective Reviews
- Communication and Collaboration
- Appeals Management
- Data Analysis and Reporting
- Compliance
Requirements (Preferred)
- Clinical Knowledge - having a strong understanding of medical terminology, clinical procedures and healthcare practices.
- Excellent verbal and written communication skills for interactions with nurses, physicians, insurance representatives etc.
- Analytical (ability to interpret data and identify trends), Organizational, Computer and Problem Solving Skills.
- Knowledge of the USA Healthcare Regulations such as HIPPA, Medicare, Medicaid, ASAM Levels.
- One to three years of experience in utilization review, case management or related field within the Behavioral Health Industry.
- Strong attention to detail and ability to adhere to strict confidential guidelines.
- Licensed Practical Nurse (LPN ), certification in healthcare administration or equivalent.
Apply Today!!!!!
Ref: 3rd Party Collections
Segoso
- 5 Southern Cross Boulevard, Montego Bay Freeport, St James Jamaica
- mobaybusiness@hotmail.com
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