Senior Utilization Review Specialist

Job Summary

To support the administrative functions of a growing telehealth platform, the full-time Senior Utilization Review Specialist will manage the utilization review process, ensuring medical necessity and appropriate levels of care while collaborating with insurance companies and clinical staff in a remote work environment.

Key responsibilities

• Oversee the entire utilization review process from admission to discharge, ensuring timely and accurate documentation
• Complete precertification processes and assist clinical staff with appeals as needed
• Train new and existing clinical staff on utilization review processes and documentation requirements

Required qualifications

• Minimum of 1 year experience in insurance verification, utilization review, or intake assessments in a relevant healthcare setting
• Experience in a business or health-related field, preferably within eating disorders treatment
• Ability to effectively interact with insurance companies and manage authorization processes
• Competency in computer-based charting and clinical software programs
• Demonstrated initiative and proactive problem-solving skills