Utilization Review Specialist
Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers spanning key geographical locations throughout the country. Praesum has serviced over 49,000 patients in various stages of health care services. With an established business model, strong finances, expert industry management team, and proven networking capabilities, Praesum looks to prosper in the $11.6 billion industry (2014 industry revenue forecast). Separate from its networks of providers, Praesum currently runs and operates eight drug and alcohol detoxification centers in Florida, New Jersey, Georgia and Massachusetts, as well as ten outpatient counseling centers in New Jersey and New York.
Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings.
• Initiate pre-certification and continued stay authorizations based on ASAM criteria
• Communicate directly with facility regarding patients’ needs and symptomology
• Maintain daily census scheduling all new admissions and concurrent reviews
• Input of authorizations and appropriate demographic information to EHR for billing purposes
• Completing “peer to peer” reviews and scheduling “Doctor to Doctor” reviews when needed
• Confirm insurance coverage of each patient
• Organize weekend census of all detox and residential patients for all our impatient facilities
• Collect all appropriate clinical data for each patient that requires precertification
• High School Diploma
• A minimum of 1-2 years of utilization review experience.
• Individual must be computer literate with proficiency in Microsoft Office applications.
• Full Time, Saturday - Wednesday (weekends) with potential for bonus
• 8:30am to 05:00pm
• Hourly rate competitive with experience and location
• Potential for bonus
Full time employees may be eligible for the following:
• Insurance : Medical, Dental, Vision, and STD/LTD options
• Medical FSA and Dependent Care Account
• $25,000.00 Basic Life Insurance
• 401k with company match
• Accrued PTO Plan
• Education reimbursement
• Career Advancement Opportunities
*** This job does NOT sponsor visa's and we are unable to consider out of country applicants ***
If you are interested in this opportunity or know someone that you respect who would be a good fit for this position, please email:
Chase@praesumhealthcare.com Director of Talent Acquisition, Chase
RDavis@praesumhealthcare.com Executive Recruiter, Ray