Utilization Review Coordinator

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

📋 Description

• Perform daily communication with insurance providers to obtain authorizations for behavioral health and substance use disorder treatments.

• Oversee a caseload of active authorizations, meticulously monitoring timelines as they directly impact patient care.

• Utilize knowledge of substance use disorder (SUD) and behavioral health levels of care, including detox, residential, PHP, IOP, and outpatient services, when engaging with payers.

• Refer to ASAM criteria and medical necessity guidelines to bolster authorization requests.

• Employ systems such as KIPU, Availity, or other payer portals to document and monitor review activities.

• Maintain professional and consistent communication with insurance representatives and internal clinical teams.

• Operate independently while adhering to program and compliance standards.

⛳️ Requirements

• A high school diploma or equivalent is required; an associate's or bachelor's degree is advantageous.

• Less than one year of relevant experience is required; training will be provided for the right candidate.

• Experience in utilization review, insurance authorization, or behavioral health billing is preferred.

• Familiarity with SUD/behavioral health levels of care (detox, residential, PHP, IOP, OP) is a significant advantage.

• Understanding of ASAM criteria and medical necessity standards is a plus.

• Experience with KIPU, Availity, or payer portals is preferred.

• Excellent organizational abilities and attention to detail.

• Effective and professional communication skills.

• Ability to work independently and manage a caseload effectively.

• Reliable home internet connection and a private, HIPAA-compliant workspace for remote work.

🏝️ Benefits

• Salary: $50,000 to $80,000 annually, based on experience.

• Schedule: Full-time days, remote (hybrid option available for the right candidate).