Licensed Utilization Review Specialist

Job Summary

As a key member of the team, the Licensed Utilization Review Specialist will work remotely in a full-time capacity, ensuring clinically appropriate care and cost-effective utilization of services through ongoing clinical review of patients from admission to discharge.

Key Responsibilities

• Apply utilization criteria to monitor appropriateness of admissions and continued stay reviews
• Communicate with third-party payers for initial and concurrent clinical reviews
• Document actions and ensure patient charts meet medical necessity criteria

Required Qualifications

• Master's Degree in Social Sciences or equivalent experience required
• Active substance abuse or mental health licensure in the relevant state
• At least 1 year of experience in a relevant field
• Ability to exercise discretion and independent judgment in job performance
• In-depth knowledge of disease processes, medical terminology, and utilization review