Behavioral Health Utilization Review Specialist

Job Summary

Working remotely in a full-time capacity, the Behavioral Health Utilization Review Specialist will manage the authorization of treatment through insurance and managed care companies, performing pre-certification, concurrent, and appeal reviews while ensuring compliance with relevant regulations.

Key Responsibilities

• Act as the liaison with insurance and managed care companies for treatment authorization, representing the agency professionally
• Monitor compliance with State and Federal laws and regulations related to insurance and third-party payers
• Process data in conjunction with a compliance consultant, presenting it effectively using established statistical methods

Required Qualifications

• BA in Psychology or a related field
• Three to five years of experience in Case Management/Utilization Review in a Substance Abuse environment
• Knowledge of ASAM guidelines and medical terminology
• Familiarity with State and Federal Statutes regarding patient confidentiality laws
• Experience with KIPU; Best Notes experience is a plus