Utilization Review Specialist

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

📋 Description

• Execute pre-authorizations, concurrent reviews, and internal utilization review evaluations.

• Collaborate with multidisciplinary treatment team members to gather information necessary for concurrent reviews.

• Arrange peer-to-peer reviews and manage urgent/expedited appeals.

• Consult with physicians for individual case staffing as required.

• Adhere to the policies and procedures set by the Utilization Review Department.

• Employ the UR Census Report on a daily basis.

• Make all initial calls within 24 hours and follow up every 24 hours.

• Conduct data entry and manage records effectively.

• Assist with the appeals process as needed.

• Complete thorough daily documentation.

• Collaborate with the Finance Department regarding client service authorizations.

• Maintain frequent communication with the treatment team.

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor’s degree in a health or behavioral health-related field is required, or a High School diploma/equivalent with a State license (e.g., Registered Nurse, Licensed Practical Nurse, LCSW, LMHC) is preferred.

• A graduate degree in a health or behavioral health-related field is preferred.

• At least three years of experience in a psychiatric or chemical dependency environment is required.

• A minimum of three years of experience in Utilization Review is preferred.

• State licensure is preferred (Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, Licensed Mental Health Counselor).

• Proficient in establishing and maintaining effective communication with managed care companies.

• Ability to coordinate medical and counseling staff to ensure timely provision of services at the appropriate level of care in accordance with the patient’s condition and compliance with governmental and accrediting standards.

• Familiarity with concurrent reviews, utilization review, census reports, and ASAM criteria.

• Capable of being resourceful and proactive when addressing arising issues.

• Strong organizational skills with the ability to multitask, prioritize, and perform under pressure.

• Effective time management skills.

🏝️ Benefits

• Starting salary of $50,000 per year, based on experience.

• Paid Time Off: Up to 2 weeks of annual paid time off, plus sick leave and holiday pay.

• Benefits commence on the first day of the month following your hire date.

• Matching HSA - the company contributes up to $1500 per year to your HSA.

• 401(k) plan available.

• Comprehensive medical, dental, and vision insurance.

• Complimentary Telehealth access.

• Employee Referral Bonus - potential to earn up to $4000.