ApplyJob Type
Full-timeDescription
Full-time, Thursday to Monday
On-site, Delray Beach, FL
Zinnia Health is a fast-growing integrated healthcare company. We value our employees and care for our clients. Do you have unique talents that you would like to share with others? We would love to have you join our team!
- Competitive Pay
- Career Development
- Competitive Benefits & 401k
- Values: Integrity, Teamplay, 1% Better Each Day
We are seeking a Utilization Review Specialist that has experience with medical record auditing in the substance abuse treatment field. The Utilization Review Specialist is responsible for managing the review process for client services to ensure the appropriate utilization of resources within a substance abuse treatment facility. This role involves evaluating patient treatment plans, ensuring compliance with healthcare regulations, and working closely with clinical staff to optimize patient care while maintaining cost-effectiveness.
RESPONSIBILITIES
Review and Evaluation:
- Conduct thorough reviews of patient treatment plans and medical records to ensure services meet clinical guidelines and regulatory requirements.
- Evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
Authorization and Documentation:
- Obtain necessary pre-authorizations and ongoing authorizations for treatment services from insurance companies and other payers.
- Document and maintain detailed records of reviews, decisions, and communications with healthcare providers and payers.
Compliance and Regulation:
- Ensure compliance with all federal, state, and local regulations, including HIPAA and other confidentiality standards.
- Stay current with changes in healthcare regulations and payer requirements.
Collaboration and Communication:
- Work closely with clinical staff to ensure treatment plans are appropriate and adjusted as needed.
- Communicate effectively with insurance companies, third-party payers, and other external entities to advocate for patient care needs.
- Provide education and training to clinical staff on utilization review processes and best practices.
- Assist in developing and implementing policies and procedures related to utilization review.
QUALIFICATIONS
- Minimum high school diploma/GED. Bachelor's degree in social work, health administration, or a related field preferred.
- Minimum of 1 year of experience in the field
- Strong analytical and critical thinking skills.
- Excellent communication and interpersonal skills.
- Proficiency in healthcare software and electronic health records (EHR) systems.
- Ability to work independently and as part of a multidisciplinary team.
- Knowledge of substance abuse treatment modalities and practices.
Salary Description$23-$28 hourly
