Full-Time
Utilization Management Specialist
Integrated Resources
501-1,000 employees
No salary listed
Miami, FL, USA
Hybrid
Hours: M-F 8:00am–7:00pm; 98% telephonic; travel to a local hospital may be required.
 Medical, Clinical & Veterinary (2) |
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- At least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioral Health experience Utilization Reviews experience.
- This position is 98% telephonic.
- Travel may be required to a local hospital with a mileage rate of $0.54/mile.
- Training will be 3–4 weeks long that will include Code of Conduct, Systems App and Shadowing.
- Credentialing Paperwork will be completed during training.
- Required Licenses: LCSW, LCMFC, LMHC, LMFT, LCPC or RN. OR RN, then a Bachelor Degree is required. The Master Degree is required for all other licensing.
- Hours of operation for the Department: M- F 8:00am – 7:00pm.
- Gathers and synthesizes clinical information in order to authorize services.
- Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information.
- Assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity.
- Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria.
Company Size
501-1,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Edison, New Jersey
Founded
1996
Simplify's Take
What believers are saying
- Certification boosts appeal to quality-focused healthcare organizations.
- Reskilling programs cut time-to-hire amid workforce shortages.
- Positions IRI among 15,000 Joint Commission-accredited elite firms.
What critics are saying
- Certification lapses in 12-18 months from failed onsite review.
- Patient complaints trigger decertification and client losses in 6-12 months.
- AMN Healthcare captures IRI's mid-sized clients in 12-24 months.
What makes Integrated Resources unique
- Joint Commission Gold Seal certifies IRI's staffing compliance since 2009.
- AI tool Nova hybridizes with reskilling to close healthcare skills gaps.
- Focuses on diversity hiring and performance monitoring for elite placements.
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Benefits
Wellness Program
Mental Health Support
Flexible Work Hours
Phone/Internet Stipend
Home Office Stipend
Conference Attendance Budget
Company News
Edison, New Jersey - Integrated Resources Inc. has earned The Joint Commission's Gold Seal of Approval(R) for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.
Integrated Resources Inc. has earned The Joint Commission’s Gold Seal of Approval ® for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.