We are seeking a detail-oriented and experienced Utilization Review Specialist to join our esteemed team at Bayview Recovery Center. The Utilization Review Specialist will play a crucial role in ensuring the efficient utilization of resources, compliance with insurance requirements, and continuity of care for our clients.

nsurance Verification: Verify clients' insurance coverage and benefits to determine eligibility and coverage for addiction treatment services.

Utilization Review: Conduct thorough and timely reviews of client treatment plans to ensure they meet insurance guidelines and medical necessity criteria.

Authorization Management: Collaborate with insurance companies to obtain and maintain authorizations for client treatment, ensuring continued coverage.

Documentation Review: Review and assess clinical documentation, including treatment plans, progress notes, and assessments, for accuracy and compliance with insurance requirements.

Appeals: Prepare and submit appeals for denied claims, providing all necessary documentation and supporting information.

Benefit Utilization: Monitor and track clients' benefit utilization, ensuring that treatment services are consistent with insurance coverage.

Compliance: Stay updated on insurance regulations and requirements, ensuring that the facility maintains compliance with all relevant standards.

Client Advocacy: Advocate for clients in cases of denied claims or coverage disputes, collaborating with clinical staff to provide additional information as needed.

Communication: Communicate with the treatment team, billing department, and insurance companies to resolve issues related to billing and insurance claims.

Reporting: Prepare utilization and insurance-related reports for internal and external use, as required.

• Bachelor's degree in healthcare administration, business, or a related field. Master's degree is a plus.
• Minimum of 3 years of experience in utilization review or insurance coordination within the healthcare or addiction treatment industry.
• Strong knowledge of insurance regulations, coverage guidelines, and medical necessity criteria.
• Excellent communication and interpersonal skills.
• Detail-oriented with strong analytical and problem-solving abilities.
• Ability to maintain confidentiality and adhere to ethical standards.

Why Join Bayview Recovery Center:

• Competitive salary and benefits package.
• The opportunity to make a meaningful impact on the lives of men seeking recovery.
• Collaborative and supportive work environment.
• Ongoing professional development and training opportunities.
• Enjoy the beauty of San Diego's coastal location, known for its year-round sunshine and outdoor activities.

If you are a detail-oriented professional with experience in utilization review and a passion for ensuring the continuity of care for individuals in their recovery journey, we encourage you to apply. Please send your resume and a cover letter outlining your qualifications and why you are the ideal candidate for this position to max@bayviewrecoverycenter.com.

Bayview Recovery Center is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees and clients.