Licensed Utilization Review Specialist
Job Summary
To support a growing virtual intensive outpatient program, the full-time Licensed Utilization Review Specialist will oversee caseload functions, complete pre-certifications and authorizations, and collaborate with clinical teams to enhance patient experience while working remotely.
Key responsibilities
- Oversees all functions of a virtual IOP caseload
- Completes pre-certs and authorizations for virtual IOP clients in a timely manner
- Collaborates with clinical teams and management to troubleshoot workflows and improve efficiency
Required qualifications
- Active, unrestricted professional license to practice independently in a U.S. state or territory
- 2+ years of experience in a utilization role within the behavioral health field
- 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
Complete Job Description
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