Utilization Review Specialist

Job Description

Job Description

Why Charlie Health?

Millions of people across the country are navigating mental health conditions, substance use disorders, and eating disorders, but too often, they're met with barriers to care. From limited local options and long wait times to treatment that lacks personalization, behavioral healthcare can leave people feeling unseen and unsupported.

Charlie Health exists to change that. Our mission is to connect the world to life-saving behavioral health treatment. We deliver personalized, virtual care rooted in connection—between clients and clinicians, care teams, loved ones, and the communities that support them. By focusing on people with complex needs, we're expanding access to meaningful care and driving better outcomes from the comfort of home.

As a rapidly growing organization, we're reaching more communities every day and building a team that's redefining what behavioral health treatment can look like. If you're ready to use your skills to drive lasting change and help more people access the care they deserve, we'd love to meet you.

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. 

• 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 

• 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 

Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here.

The total target base compensation for this role will be between $62,000 and $70,000 per year at the commencement of employment. In addition to base compensation, this role also offers a performance bonus. The expected total cash compensation range, including potential bonus, will be between $0 and $900 per month. Please note, pay will be determined on an individualized basis and will be impacted by location, experience, expertise, internal pay equity, and other relevant business considerations. Further, cash compensation is only part of the total compensation package, which, depending on the position, may include stock options and other Charlie Health-sponsored benefits. #LI-REMOTE

#LI-REMOTE

Our Values

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

Please do not call our public clinical admissions line in regard to this or any other job posting.

Please be cautious of potential recruitment fraud. If you are interested in exploring opportunities at Charlie Health, please go directly to our Careers Page: -openings. Charlie Health will never ask you to pay a fee or download software as part of the interview process with our company. In addition, Charlie Health will not ask for your personal banking information until you have signed an offer of employment and completed onboarding paperwork that is provided by our People Operations team. All communications with Charlie Health Talent and People Operations professionals will only be sent from @charliehealth.com email addresses. Legitimate emails will never originate from gmail.com, yahoo.com, or other commercial email services.

Recruiting agencies, please do not submit unsolicited referrals for this or any open role. We have a roster of agencies with whom we partner, and we will not pay any fee associated with unsolicited referrals.

At Charlie Health, we value being an Equal Opportunity Employer. We strive to cultivate an environment where individuals can be their authentic selves. Being an Equal Opportunity Employer means every member of our team feels as though they are supported and belong. We value diverse perspectives to help us provide essential mental health and substance use disorder treatments to all young people.

Charlie Health applicants are assessed solely on their qualifications for the role, without regard to disability or need for accommodation.

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