Licensed Utilization Review Clinician

Job Summary

A company is looking for a Utilization Review Clinician to conduct administrative and professional support for claims processing.

Key Responsibilities

• Manage authorizations for programs, including prior authorization and appeals
• Support treatment teams by discussing covered services and necessary clinical documentation
• Engage in clinical rounds and provide feedback on authorization requirements for services

Required Qualifications

• Master's degree in counseling, social work, or a related field; Bachelor's in nursing preferred
• Current state licensure strongly preferred
• Availability to work 8-4:30pm CST, Monday to Friday
• Minimum one year of experience in facility-based care and utilization review methods
• Knowledge of Medicare, Medicaid, and managed care systems preferred