Utilization Management Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead and manage the reporting of utilization statistics and trends.

• Collaborate with all services to ensure the implementation of effective treatment plans for all patients.

• Engage with managed care organizations, external reviewers, and other payers.

• Provide guidance to the clinical team on the documentation required to support admission and continued stay at the most suitable level of care.

• Apply clinical information and Behavioral & Mental Health Medical Necessity criteria to communicate care plans to insurance case managers, facility staff, and healthcare partners.

• Work together with Admissions and Billing to enhance the commercial insurance authorization process.

• Maintain logs and databases related to utilization management, fiscal management, care coordination activities, and performance improvement metrics.

• Perform prospective, concurrent, and retrospective reviews utilizing telephonic information, medical records, and/or faxed medical data; establish single cases as needed.

⛳️ Requirements

• Prior experience in Utilization Review.

• Previous work experience in the field of mental health or behavioral health.

🏝️ Benefits

• Comprehensive benefits package: medical, dental, and vision.

• 401k with a 4% match.

• Paid Time Off Programs including vacation, holidays, and illness.