Utilization Review Specialist I

Who are we? For over fifty years, Aspire Health Partners has been one of the leading non-profit behavioral health companies in the Southeast. Serving nearly 40,000 clients per year, with locations in six Central Florida counties and currently expanding into Hinesville, Georgia Aspire has delivered state-of-the-art behavioral healthcare and is regularly sought out both statewide and nationally as an expert in the field. With its mission of providing the highest quality of compassionate, comprehensive, and cost effective integrated behavioral healthcare, Aspire, through its more than two dozen campus locations provides a comprehensive continuum of services for children, adolescents, adults, seniors, and families. Through innovative, resourceful treatment and recovery approaches Aspire offers individuals and families the opportunity to “aspire” to healthier, happier, and more independent lives. Aspire employs more than 1,200 professionals and paraprofessionals dedicated to Saving Lives, Transforming Communities and Changing the World

Who You Are: You're a leader looking for an opportunity to define your own career path, connect with a supportive community of health professionals like you, and increase your earning potential. You have a passion for working in different care settings and making a difference in lives.

Job Purpose: As a Utilization Review Specialist I at Aspire Health Partners, your job purpose will be to provide a multitude of duties in order to coordinate and provide insurance Utilization Review for all hospitalized clients while maintaining a high standard of ethical and professional conduct while adhering to agency policies and procedures.

Job Functions:

1. 1. Obtaining authorizations and approvals from Medicare/Medicaid MMAs and Commercial Insurance companies for all patients.
2. 2. Reviews individual charts for their appropriateness for Continuing Stay Criteria and proper utilization of services
3. 3. Maintains detailed records of all activities and authorizations
4. 4. Helps train staff to produce proper documentation
5. 5. When needed, attends treatment team meetings to gather additional clinical data
6. 6. Ability to work with little to no supervision
7. 7. Most importantly, all functions must be completed while maintaining high standards of ethical and professional conduct while adhering to agency policies and procedures.

Position qualifications: Ability to receive and maintain a(n)

1. Has knowledge of obtaining authorizations through Medicaid and Commercial Insurance companies
2. Has knowledge of the mental health and substance abuse fields.
3. Two years’ experience in utilization review and managed care required.
4. Must have knowledge of community resources and linkages.
5. Clinical knowledge should include crisis intervention, diagnostic guidelines, and psychopharmacology.
6. Preferred: LPN or RN experience
7. Preferred: Bachelor’s Degree and five years’ experience in a mental health setting
8. Minimum of a High School Diploma or GED (required)
9. Maintains current BLS/Healthcare Provider certification.
10. Pass a Level II Background clearance
11. Driving (required)

All the benefits and perks you need for you and your family:

We are committed to providing our employees with the support they need. At Aspire Health Partners, we offer eligible staff an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including:

• Medical, Dental, Vision, Basic Life & Supplemental Insurance, Flexible Spending & Health Savings Accounts
• Paid Time Off (PTO) (2.5 weeks your first year, up to 6 weeks at 14+ years)
• Paid Diversity & Floating Holidays (2)
• Paid Holidays (6)
• 403(b) 50% employer match up to 10% (3-year vesting cliff)
• Employee Discounts including Tickets, Retail, Hotel, Car Rental/Purchase
• Short-Term & Long-Term Disability Insurance
• HRSA Loan Forgiveness
• Employee Assistance Plan (EAP)
• Will preparation
• Funeral Planning
• Concierge Services & Travel Assistance