Utilization Review Specialist

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Charlie Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🧘 Wellness

💰 Seed Round on 2020-06

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

• 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 • 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

🎯 Requirements

• High School Diploma • 2+ years of experience in a utilization role within the utilization review field required • Google proficiency • Strong interpersonal, relationship-building and listening skills, with a natural, consultative style • Ability to energize, communicate, and build rapport at all levels within an organization • Strong project management skills, with a demonstrable ability to corral and manage details in a fast-paced, fluid 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 • Strong analytical, communication, and documentation skills • Proficiency with electronic medical records (EMR) and utilization management systems • Understanding of HIPAA and patient confidentiality requirements.

🏖️ Benefits

• Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here.