Become an Assembler! We are looking for a Utilization Review Specialist to join Assembly Health. If you are looking for a company that is focused on being the best in the industry, love being challenged, and make a direct impact on our business, then look no further!  We are adding to our motivated team that pride themselves on being client-focused, biased to action, improving together, and insistent on excellence and integrity.

This is a full-time, non-exempt position reporting to the U/R Manager.

• Evaluate patient medical records to determine the necessity and appropriateness of services provided.
• Analyze utilization data to identify trends, patterns, and opportunities for improvement.
• Provide recommendations to improve efficiency and effectiveness of care delivery.
• Manage utilization review schedule with providers and carriers
• Communicate with behavioral health providers to obtain necessary information and clarify clinical details.
• Communicate with insurance companies to resolve coverage issues and denials.
• Collaborate with medical and administrative staff to ensure compliance with established protocols and guidelines.
• Ensure that patient care meets regulatory requirements, accreditation standards, and payer requirements.
• Conduct reviews in a timely manner for each patient
• Stay updated on changes in regulations, standards, and guidelines affecting utilization review practices.
• Obtain prior authorizations for services as required by insurance companies and other payers.
• Monitor authorization periods and ensure timely renewals.
• Maximize authorizations from insurance providers for all levels of care
• Maintain accurate and detailed records of reviews, decisions, and communications.
• Effectively report and resolve any issues that affect authorizations
• Prepare and submit required reports to management, payers, and regulatory agencies.
• Review and appeal denied services as necessary, providing appropriate clinical information and documentation.
• Attends UR meetings to discuss activities/needs of UR department
• Execute additional duties as assigned, demonstrating diligence and meticulous attention to detail.

• Experience in healthcare, behavioral health (mental health, chemical dependency, or psychiatric nursing) preferred.  
• Minimum of one year experience in utilization review.
• Comfortable working with common billing and EMR/EHR software
• Familiar with both inpatient and outpatient levels of care (MH and SUD)
• Knowledgeable of standard medical necessity criteria
• Adherence to strict confidentiality standards to safeguard patient care information and protect patient rights.
• Solid command of Microsoft Office applications, Google Suite, Adobe Acrobat, and other technologies
• Strong attention to detail and accuracy in data entry and financial records maintenance.
• Capability to manage multiple tasks and prioritize workload to meet deadlines.
• Keen Attention to Detail, Dependable, accountable, quick learner
• Exceptional interpersonal skills, organized, positive attitude, excellent verbal and written skills, excellent organizational skills, self-motivated and driven.
• Complies with all performance measuring regarding pre-certification, concurrent reviews, and appeals.
• Ability to function well in a fast-paced and at times stressful environment.
• Prolonged periods of sitting at a desk and working at a computer. Ability to lift and carry items weighing up to 10 pounds at times.

• Be part of something special! We are growing both organically and through acquisitions.
• Career growth - your next role with Assembly might not be created yet and we are waiting for your help to chart the way!
• Ongoing training and development programs.
• An environment that values transparency
• Competitive Benefit Packages available, Paid Holidays, and Paid Time Off to enjoy your time away from the office.