Trabajos insurance utilization review en Freehold, New JerseyCrear alertas

Job DescriptionPosition Summary The Utilization Review (UR) Specialist is responsible for obtaining and maintaining insurance authorizations for clients receiving substance use disorder treatment services. This position works closely with clinical staff, admissions, and insurance companies to ensure medical necessity documentation is accurate, authorizations are obtained timely, and reimbursement is maximized while maintaining compliance with payer requirements, Medicaid regulations, and accreditation standards. Essential Duties and Responsibilities • Obtain initial and concurrent insurance authorizations for all levels of care., • Review clinical documentation to ensure it supports medical necessity., • Submit clinical information to insurance companies within required timeframes., • Monitor authorization expiration dates and request extensions before expiration., • Communicate authorization decisions and payer requirements to clinical staff., • Track approved days and notify leadership of denials or reductions in care., • Prepare and submit appeals for denied services when appropriate., • Maintain accurate authorization records in the electronic health record (EHR)., • Work collaboratively with Admissions, Clinical, Nursing, and Billing departments., • Verify insurance benefits and coverage when necessary., • Monitor payer portals for authorization updates., • Assist with Medicaid and managed care authorization processes., • Participate in utilization review meetings and case conferences., • Generate reports on authorization status, denials, appeals, and payer trends., • Ensure compliance with Joint Commission, state, federal, and payer regulations., • Maintain confidentiality in accordance with HIPAA regulations., • Perform other duties as assigned.Qualifications, • High school diploma required; Associate's or Bachelor's degree preferred., • Minimum of two years of utilization review, case management, medical billing, or behavioral healthcare experience preferred., • Experience in substance use disorder or behavioral health treatment strongly preferred., • Knowledge of ASAM Criteria preferred., • Familiarity with Medicaid, commercial insurance, and managed care plans., • Strong organizational and time management skills., • Excellent verbal and written communication skills., • Ability to prioritize multiple cases in a fast-paced environment., • Proficient in Microsoft Office and electronic health record systems.Knowledge, Skills, and Abilities, • Understanding of insurance authorization processes., • Knowledge of medical necessity criteria and documentation standards., • Strong analytical and critical thinking skills., • Excellent customer service and professional communication., • Ability to work independently while collaborating with interdisciplinary teams., • Attention to detail and accuracy., • Ability to maintain confidentiality.Performance Expectations, • Maintain timely insurance authorizations with minimal lapses., • Reduce avoidable authorization denials., • Ensure documentation meets payer standards., • Maintain accurate records and reporting., • Demonstrate professionalism, teamwork, and excellent customer service., • Comply with all organizational policies, HIPAA, Joint Commission standards, and applicable federal and New Jersey regulations.

About the OpportunityThis is an open position with Jersey Central Power & Light, a subsidiary of FirstEnergy Corp. The Senior Capital Specialist - NJ Distribution Engineering conducts financial analysis, data interpretation and information presentations to the leadership team for review and analysis. The business analyst works closely with stakeholders to identify goals, best practices, and other active methods for gathering and analyzing information as it relates to the needs of the organization. This individual provides insights that help the decision-making process and align capital and resource allocation within the business budget. The business analyst drives fresh initiatives for safety, financial planning and business data utilization and identifies business areas that can be improved for safety performance, increased efficiency, and strengthen business processes. The business analyst works closely with others throughout state operations to communicate their findings and helps implement changes to support state model objectives.This position can report onsite to either the Morristown General Office in Morristown, NJ or the Holmdel Office in Holmdel, NJ. Other service centers in JCP&L will be considered. Candidates must reside or be willing to relocate to the NJ area of operations for further consideration.Responsibilities include:Compiling and interpreting data, from various resources, in a concise and professional mannerDeveloping charts, tables, presentations, and other elements of data visualization Identifying and prioritizing the organization's functional and technical needs and requirementsCreating models and reports to support business decisionsUnderstanding business strategies, goals, and requirementsForecasting, budgeting, and performing both variance analysis and financial analysisSupporting other business units with data requests; Workforce Development, Business ServicesBuilding respectful and effective working relationships with state leaders and key stakeholders in multiple business units to work collaboratively on various requests and initiativesCollaborating with state leaders on various data requests and providing interpretationDescribing opportunities and solutions for the business modelTimely responding to requestsProviding storm support, as required, including off-hours, weekends, and holidaysDelivering quality and accurate work within established deadlinesQualificationsBachelor’s degree in Business, Finance, Accounting, Economics, Engineering or related discipline and minimum 10 years’ related work experience is required.In lieu of a degree, minimum 13 years’ related work experience is required. Related work experience includes planning/analysis, performance reporting, forecasting, and budgeting.Advanced degree or professional certification preferred.A solid understanding of Microsoft Office applications – pivot tables, vlookups, filteringStrong computer application experience in the Microsoft suite; PowerPoint, Excel, and WordExcellent written and verbal communication skills with the ability to interpret and communicate dataExcellent analytical abilitiesAble to work well under pressure, manage multiple priorities and projectsAble to build strong working relationships to support leaders and business unitsUnderstanding of regulatory reporting requirementsKnowledge of Key Performance Indicators (KPI’s)Apply new technology to its fullest potential to reach operational process improvement goalsModel active learning through continuing to learn, develop breadth of knowledge, skills and perspectiveExperience in utility operations preferredBenefits, Compensation & Workforce DiversityAt FirstEnergy, employees are key to our success. We depend on their talents to meet the challenges of our changing business environment. We are committed to rewarding individual and team efforts through our total rewards philosophy which includes competitive pay plus incentive compensation, a company-sponsored pension plan, 401(k) savings plan with matching employer contribution, a choice of medical, prescription drug, dental, vision, and life insurance programs, as well as skills development training with tuition reimbursement. Please visit our website at www.firstenergycorp.com to learn more about all of our employee rewards programs. FirstEnergy proudly supports workforce diversity. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with a disability. No recruiters or agencies without a previously signed contract. Unable to sponsor or transfer H-1B visas at this time.SafetySafety is a core value for FirstEnergy and is essential to all of our business activities. We ensure employees have the tools, information, and processes to perform their duties in a manner that assures safety for themselves, their co-workers, our customers and the public. Our goals are to provide a safe work environment, to maintain an accident-free, injury-free workplace, and to promote and maintain public safety. To meet these goals, we dedicate ourselves to achieving world-class safety standards.Position ClassificationExempt FirstEnergy Human Resources TeamFull timePosting Date: 2026-05-21