Utilization Review Specialist

Utilization Review Specialist

Remote, United States

About the Role

The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the best possible length of stays for our patients. Given the complex nature of insurance these days, it is crucial to have timely communication with these payors so that families can focus on what's important, getting their loved ones the care they need.

We're a team of passionate, forward-thinking professionals eager to take on the challenge of the mental health crisis and play a formative role in providing life-saving solutions. If you're inspired by our mission and energized by the opportunity to increase access to mental healthcare and impact millions of lives in a profound way, apply today.

Responsibilities

• Oversees all functions of a virtual IOP caseload
• Collaborates at a high level to problem solve on complex cases with Manager
• Completes pre-certs and authorizations for virtual IOP clients in a timely manner
• Completes peer to peer reviews with insurance MDs to advocate for treatment post first line denial outcomes.
• Follows up on all outstanding authorizations and reports all barriers to Manager
• Collaborates with Revenue Cycle Team and Admissions to improve patient experience from the front door through discharge Partners with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems
• Delivers training to clinical teams for high quality documentation standardization
• Participate in denial management, appeals, and peer-to-peer review processes

Requirements

• Active, Unrestricted Professional License: You must hold a current, active, and unencumbered license to practice independently in a U.S. state or territory. Common credentials include:
• Physicians: MD or DO (typically Board Certified in Psychiatry or Child/Adolescent Psychiatry).
• Psychologists: PsyD or PhD (Licensed Psychologist).
• Master's-Level Clinicians: LCSW, LMFT, LPC, or LCPC.
• 2+ years of experience in a utilization role within the behavioral health field required
• Google proficiency
• Strong interpersonal, relationship-building and listening skills, with a natural, consultative style
• Ability to energize, communicate, and build rapport at all levels within an organization
• Strong project management skills, with a demonstrable ability to corral and manage details in a fast-paced, fluid environment
• Experience advising, presenting to, and persuading senior corporate personnel
• Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations
• Familiarity with InterQual, MCG, or similar clinical guidelines
• Strong analytical, communication, and documentation skills
• Proficiency with electronic medical records (EMR) and utilization management systems
• Understanding of HIPAA and patient confidentiality requirements

Our Values

• Connection: Care deeply & inspire hope.
• Congruence: Stay curious & heed the evidence.
• Commitment: Act with urgency & don't give up.