Job details

Utilization Review Specialist

at Endeavor House North
Location Kearny, NJ
Category Professional / Administrative
Job Type Full Time

Description

Pinnacle Treatment Centers is a leading comprehensive provider of substance abuse treatment services to individuals that are addicted to drugs and / or alcohol. Founded in 2006, the Company has grown into an organization that operates over 30 substance abuse treatment facilities in five states (Kentucky, Michigan, New Jersey, Pennsylvania, and Virginia) with additional sites under development in Ohio, Indiana, and Minnesota.

Pinnacle treats over 10,000 people daily and provides a full continuum of care, including detoxification, residential, outpatient, and transitional living programs. Treatment includes treating the individual’s physical, spiritual, emotional, and psychological selves. Pinnacle is CARF accredited and all locations include physicians, nurses, clinicians, administrative, and support staff.

We are currently seeking an experienced UR Specialist to join our team at our Endeavor House location in Kearny, NJ.

About the Position:

Summary:   This is a highly skillful position that requires an individual to work independently.  This position requires knowledge of clinical summary for all clients and excellent communications skills to process reports to behavioral health companies.  

Duties and responsibilities

  • Review with behavioral companies with updated clinical information on a timely basis.
  • Document all certification information received and advise Administration Department of any insurance problems.
  • Process appeals with managed care companies.
  • Perform assessments for new admissions.
  • Participate in multidisciplinary team meetings for clinical updates.
  • Verify insurance benefits for behavioral health levels of care.
  • Review hard copy authorizations for potential problems.
  • Assist in case management duties as assigned.
  • Effectively input all authorization daily into the agency’s billing software/database. 

SKILLS AND ABILITIES:

  • Registered Nurse, LPN or Social Worker
  • Minimum 2 years experience working in substance abuse/mental health field.
  • Knowledge and background with managed care and insurance helpful.

To apply for the position, please click here.

We offer a competitive salary along with a full benefits package, paid time off, and the opportunity for professional development and advancement.

We maintain a drug-free workplace and perform pre-employment substance abuse testing.

All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.