Utilization Review Specialist - Behavioral Health (Remote)

Employer Industry: Behavioral Healthcare Management

Why consider this job opportunity

• Starting pay up to $50,000 per year, based on experience
• Free Teladoc access and visits for employees and eligible dependents
• Comprehensive benefits beginning on the 1st day of the month following the date of hire
• Matching HSA contributions of up to $1,500 per year
• Employee Referral Bonus of up to $4,000
• Opportunity to make a tangible difference in the lives of patients and their families

What to Expect (Job Responsibilities)

• Complete pre-authorizations, concurrent reviews, and internal utilization review assessments
• Consult with the multidisciplinary treatment team to gather necessary information for concurrent reviews
• Schedule peer-to-peer reviews and coordinate urgent/expedited appeals
• Staff individual cases with medical doctors as required
• Maintain compliance with all standard utilization review policies and procedures

What is Required (Qualifications)

• Bachelor’s degree in a health or behavioral health-related field required; graduate degree preferred
• High School diploma or equivalent and a state license (e.g., Registered Nurse, Licensed Practical Nurse, LCSW, LMHC) preferred
• Minimum of three years’ experience in a psychiatric or chemical dependency setting
• Minimum of three years’ utilization review experience preferred
• State licensure preferred (Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, Licensed Mental Health Counselor)

How to Stand Out (Preferred Qualifications)

• Experience in behavioral health management or addiction treatment settings
• Familiarity with ASAM criteria and utilization review processes
• Strong organizational skills and ability to manage multiple tasks under pressure
• Excellent communication skills with managed care companies
• Proactive problem-solving skills in a healthcare environment

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