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Utilization Review Specialist

Utilization Review Specialist

New
C
Charlie HealthBehavioral Healthcare
Remote, United StatesFull-TimeMiddle
SalaryThe total target base compensation for this role will be between $62,000 and $70,000 per year... In addition to base compensation, this role also offers a performance bonus. The expected total cash compensation range, including potential bonus, will be between $0 and $900 per month.
Apply NowOpens the employer's application page

Job Details

Experience
2+ years of experience in a utilization role within the behavioral health field
Required Skills
Project ManagementGoogle WorkspaceHIPAA

Requirements

  • Active, unrestricted professional license to practice independently in a U.S. state or territory (e.g., MD, DO, PsyD, PhD, LCSW, LMFT, LPC, LCPC)
  • 2+ years of experience in a utilization role within the behavioral health field
  • Proficiency with electronic medical records (EMR) and utilization management systems
  • Familiarity with InterQual, MCG, or similar clinical guidelines
  • Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations
  • Strong project management skills with ability to manage details in a fast-paced environment
  • Strong analytical, communication, and documentation skills
  • Google Workspace proficiency
  • Ability to advise, present to, and persuade senior corporate personnel
  • Strong interpersonal and relationship-building skills
  • Understanding of HIPAA and patient confidentiality requirements

Responsibilities

  • Oversee all functions of a virtual IOP caseload
  • Collaborate at a high level to problem solve on complex cases with Manager
  • Complete pre-certs and authorizations for virtual IOP clients in a timely manner
  • Complete peer to peer reviews with insurance MDs to advocate for treatment post first line denial outcomes
  • Follow up on all outstanding authorizations and report all barriers to Manager
  • Collaborate with Revenue Cycle Team and Admissions to improve patient experience from the front door through discharge
  • Partner with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains
  • Deliver training to clinical teams for high quality documentation standardization
  • Participate in denial management, appeals, and peer-to-peer review processes
View Full Description & ApplyYou'll be redirected to the employer's site
The total target base compensation for this role will be between $62,000 and $70,000 per year... In addition to base compensation, this role also offers a performance bonus. The expected total cash compensation range, including potential bonus, will be between $0 and $900 per month.
Apply Now