Utilization Review Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $62k - $70k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Charlie Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

💰 Seed Round on 2020-06

Healthcare • Healthcare Insurance • Wellness

Charlie Health is a provider of personalized intensive therapy and virtual Intensive Outpatient Programs (IOP) targeting mental health challenges. They cater to both teens and adults, offering a comprehensive treatment approach that includes therapies such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and art and music therapy, among others. The company aims to provide immediate access and flexible scheduling to accommodate patients' needs, focusing on various conditions like anxiety, depression, self-harm, and substance use disorders. Charlie Health emphasizes measurable outcomes and connection with peers to foster long-term healing, with services available in as little as 24 hours.

📋 Description

• Oversee all functions of a virtual IOP caseload • Collaborate with the Manager to problem-solve complex cases • Complete pre-certifications and authorizations for virtual IOP clients • Conduct peer-to-peer reviews with insurance medical directors after first-line denials • Follow up on outstanding authorizations and report barriers to the Manager • Collaborate with Revenue Cycle and Admissions to improve the patient experience from intake through discharge • Partner with the Manager and Director to troubleshoot workflows and processes and achieve efficiency gains • Deliver training to clinical teams on high-quality documentation standardization • Participate in denial management, appeals, and peer-to-peer review processes

🎯 Requirements

• Current, active, and unencumbered professional license to practice independently in a U.S. state or territory • Physicians: MD or DO, typically Board Certified in Psychiatry or Child/Adolescent Psychiatry • Psychologists: PsyD or PhD and Licensed Psychologist • Master’s-level clinicians: LCSW, LMFT, LPC, or LCPC • 2+ years of experience in a utilization role within the behavioral health field • Google proficiency • Strong interpersonal, relationship-building, listening, analytical, communication, and documentation skills • Ability to energize, communicate, and build rapport at all organizational levels • Strong project management skills and 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

🏖️ Benefits

• Comprehensive benefits for all full-time, exempt employees • Performance bonus • Potential stock options • Other Charlie Health-sponsored benefits