Utilization Review Specialist (Psychologist) at Tranquil & Quest Medical and Diagnostics Limited

Job Overview:

• The Utilization Review Specialist (Psychologists) will support our Utilization Review department by working closely with patients, insurance companies, and the entire treatment team.

Job Responsibilities:

• Act as an advocate for patients to ensure their treatment needs are met.
• Interact with insurance companies in a professional manner.
• Complete precertification and concurrent reviews with insurance companies to obtain authorization for treatment.
• Act as a resource to the medical and clinical staff for all issues relating to utilization management.
• Support therapeutic team members and participate in team activities.
• Perform other duties and projects as assigned.

Qualifications:

• Masters in Mental Health or Psychiatric Nursing.
• Independent licensure in Mental Health or Psychiatric Nursing preferred.
• Must have at least 5 years of clinical experience.
• Must possess strong clinical assessment skills.
• Be a strong team player who works well in a collaborative-team environment.
• Experience completing pre-certifications and concurrent reviews preferred.
• Able to organize daily schedule and prioritize cases according to level of care and due dates.