Utilization Review Specialist
New
C
Charlie HealthBehavioral Healthcare
Remote, United StatesFull-TimeMiddle
Salary$62,000 and $70,000 per year
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Job Details
- Experience
- 2+ years
- Required Skills
- Project ManagementGoogle WorkspaceHIPAA
Requirements
- Active, Unrestricted Professional License: Must hold a current, active, and unencumbered license to practice independently in a U.S. state or territory.
- Common credentials include MD, DO, PsyD, PhD, LCSW, LMFT, LPC, or LCPC.
- 2+ years of experience in a utilization role within the behavioral health field.
- Google proficiency.
- Strong interpersonal, relationship-building and listening skills.
- Strong project management skills, with a demonstrable ability to manage details in a fast-paced environment.
- Experience advising, presenting to, and persuading senior corporate personnel.
- Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations.
- Familiarity with InterQual, MCG, or similar clinical guidelines.
- Proficiency with electronic medical records (EMR) and utilization management systems.
- Understanding of HIPAA and patient confidentiality requirements.
Responsibilities
- Oversees all functions of a virtual IOP caseload.
- Collaborates at a high level to problem solve on complex cases with Manager.
- Completes pre-certs and authorizations for virtual IOP clients in a timely manner.
- Completes peer to peer reviews with insurance MDs to advocate for treatment post first line denial outcomes.
- Follows up on all outstanding authorizations and reports all barriers to Manager.
- Collaborates with Revenue Cycle Team and Admissions to improve patient experience from the front door through discharge.
- Partners with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems.
- Delivers training to clinical teams for high quality documentation standardization.
- Participate in denial management, appeals, and peer-to-peer review processes.
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