Utilization Review Specialist

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

📋 Description

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

• Work in conjunction with the Manager to resolve intricate case issues.

• Handle pre-certifications and authorizations for virtual IOP clients.

• Engage in peer-to-peer discussions with insurance medical directors following initial denials.

• Track outstanding authorizations and communicate any obstacles to the Manager.

• Collaborate with Revenue Cycle and Admissions to enhance the patient journey from intake to discharge.

• Partner with the Manager and Director to identify and resolve workflow inefficiencies.

• Provide training to clinical teams on the standardization of high-quality documentation.

• Involve yourself in denial management, appeals, and peer-to-peer review activities.

⛳️ Requirements

• Must possess a current, active, and unencumbered professional license to practice independently in a U.S. state or territory.

• For Physicians: MD or DO, typically Board Certified in Psychiatry or Child/Adolescent Psychiatry.

• For Psychologists: PsyD or PhD and Licensed Psychologist.

• For Master’s-level clinicians: LCSW, LMFT, LPC, or LCPC.

• A minimum of 2 years’ experience in a utilization role within the behavioral health sector.

• Proficiency in Google applications.

• Excellent interpersonal, relationship-building, listening, analytical, communication, and documentation skills.

• Capability to energize, communicate, and establish rapport across all organizational levels.

• Strong project management abilities and adeptness at handling details in a fast-paced setting.

• Experience in advising, presenting to, and persuading senior corporate officials.

• Familiarity with utilization review processes, medical necessity standards, and healthcare regulations.

• Knowledge of InterQual, MCG, or other similar clinical guidelines.

• Competence in using electronic medical records (EMR) and utilization management systems.

• Awareness of HIPAA and patient confidentiality obligations.

🏝️ Benefits

• Comprehensive benefits package for all full-time, exempt employees.

• Performance-based bonus.

• Possible stock options.

• Additional benefits sponsored by Charlie Health.