Utilization Review Specialist

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

📋 Description

• Reach out to insurance providers to confirm coverage and secure approval for treatments recommended by the clinical team.

• Partner with the clinical team to assemble treatment plans and the necessary clinical documentation.

• Collaborate with various internal departments, including Revenue Cycle and Patient Advocates.

• Ensure accurate documentation in electronic medical records to reflect the approval or denial of treatment authorizations.

• Relay information regarding insurance authorizations, denials, and related needs to the appropriate internal staff.

• Schedule and conduct concurrent authorization reviews as mandated by specific insurance companies.

• Coordinate reviews and appeals with physicians.

• Serve as the intermediary between the clinical team and insurance companies.

• Ensure the maintenance of insurance approvals throughout the duration of patients’ treatment.

• Advocate for patients to help them navigate financial barriers to treatment.

⛳️ Requirements

• Bachelor’s Degree (preferred) or relevant experience in the field.

• Prior experience in healthcare or insurance sectors.

• Familiarity with medical terminology and psychiatric criteria.

• Ability to analyze and relay clinical information derived from progress notes, group notes, and psychiatric charts.

• Capacity to work autonomously while also collaborating effectively as part of a team.

• Proficiency in critical thinking and decision-making within the scope of individual responsibilities.

• Excellent written and verbal communication skills.

• Strong organizational and time management abilities, with a capability to manage workload independently.

• Ability to build and maintain positive relationships both externally and internally.

• Proficient in Microsoft Office, Outlook, and EMR systems.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance plans.

• 401k plan with company matching contributions.

• Generous paid time off (PTO).

• Competitive parental leave available after one year of employment.

• Ongoing training opportunities through CEU seminars.

• Options for volunteering within the community.

• Opportunities for career growth and ongoing development within the organization.