Utilization Review Specialist

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

📋 Description

• Manages all aspects of a virtual Intensive Outpatient Program (IOP) caseload.

• Engages in high-level collaboration to resolve complex cases alongside the Manager.

• Efficiently processes pre-certifications and authorizations for virtual IOP clients.

• Monitors all pending authorizations and communicates any obstacles to the Manager.

• Works in partnership with the Revenue Cycle Team and Admissions to enhance the patient experience from entry to discharge.

• Collaborates with the Manager and Director to identify and resolve workflow and process issues to enhance efficiency in existing and future company systems.

• Provides training to clinical teams to ensure standardization of high-quality documentation.

• Engages in denial management, appeals, and peer-to-peer review processes.

⛳️ Requirements

• High School Diploma.

• A minimum of 2 years of experience in a utilization role within the utilization review field is required.

• Proficient in Google applications.

• Excellent interpersonal, relationship-building, and listening skills, with a natural consultative approach.

• Capable of energizing, communicating, and establishing rapport at all organizational levels.

• Strong project management abilities, with a proven track record of managing details in a dynamic, fast-paced environment.

• Experience in advising, presenting to, and influencing 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.

• Proficient with electronic medical records (EMR) and utilization management systems.

• Understanding of HIPAA and patient confidentiality regulations.

🏝️ Benefits

• Charlie Health is proud to offer comprehensive benefits to all full-time, exempt employees. Learn more about our benefits here.