Utilization Review Specialist

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

📋 Description

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

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

• Ensures timely completion of pre-certifications and authorizations for virtual IOP clients.

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

• Works together 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 issues, aiming for efficiency improvements in existing and future company systems.

• Provides training to clinical teams to standardize high-quality documentation practices.

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

⛳️ Requirements

• A High School Diploma is required.

• Minimum of 2 years of experience in a utilization role within the utilization review sector is essential.

• Proficiency in Google applications.

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

• Capacity to energize, communicate effectively, and establish rapport at all organizational levels.

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

• Experience in advising, presenting to, and influencing senior corporate leaders.

• Understanding of utilization review processes, medical necessity criteria, and relevant healthcare regulations.

• Familiarity with clinical guidelines such as InterQual, MCG, or similar frameworks.

• Strong analytical, communication, and documentation skills.

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

• Knowledge of HIPAA regulations and patient confidentiality standards.

🏝️ Benefits

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