Centered Health Hiring for Utilization Review Specialist Job at Culver City, CA Full Time

If you are looking for an exciting career in a beautiful, serene, and friendly environment, look no further! We are seeking a Utilization Review Specialist.

Centered Health offers above market compensation, fantastic medical, dental and vision benefits, 401k company match, company sponsored Long Term Disability and Life Insurance. 16 days of paid time off, in additional to the major legal holidays.

We provide a beautiful complimentary café with fresh ground gourmet coffee, lattes etc., loads of snacks, fresh fruit, yogurt, and ION filtered water/ice machine and weekly lunch. We are conveniently located off the 405 freeway in Culver City in a newly renovated office building with plenty of parking!

You will get a brand new (everything is new) beautiful large workstation with a standing desk and lots of natural sunlight.

Salary Range: $25.00-$30.00

Please note: This is NOT a remote position

JOB DESCRIPTION:

Seeking an experienced utilization review specialist. The candidate should posses sufficient experience in obtaining out of network authorization from insurances. Additionally, qualified candidates are expected to have prior experience working with mental health, substance abuse, and eating disorder facilities, this does not just mean dual diagnosis. It is required that the qualified candidate have a record of success in obtaining single case agreements and MUST have strong knowledge in the different levels of care for behavioral health. The candidate must have a working knowledge of documentation requirements for major payors and the ability to audit medical records to ensure compliance daily. The candidate should also have a working knowledge of programming requirements for all major payors.

REQUIREMENTS:

• Minimum two years of experience with obtaining authorization for adolescents and adults
• Candidate has experience working with detox, residential treatment, PHP, and IOP level of care.
• Must have successful experience obtaining single case agreements with EPOs, HMOs, and PPOs
• Experience working with out of network PPO insurance
• Experience with quality assurance audits
• Familiarity with the appeals and retrospective authorization process
• Working knowledge of programming/clinical requirements for the major health plans (Optum, Anthem, Cigna, BCBS, etc.)
• Health Screen/TB
• Background Check

APPLY TODAY to be a part of an energetic and motivated team of professionals!

Job Type: Full-time

Pay: $25.00 – $30.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work Location: One location