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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