State Licensed Utilization Review Specialist

Job Summary

Working remotely in a full-time capacity, the State Licensed Utilization Review Specialist will manage pre-authorizations, concurrent reviews, and assist the treatment team in navigating insurance requirements for patient care.

Key responsibilities

• Completes pre-authorizations and concurrent reviews while consulting with the multidisciplinary treatment team
• Schedules peer-to-peer reviews and coordinates urgent appeals, ensuring timely communication with managed care companies
• Maintains detailed documentation and manages records, collaborating with the Finance Department on client service authorizations

Required qualifications

• Bachelor's degree in a health or behavioral health related field required; graduate degree preferred
• High School diploma or equivalent with a State license (e.g., RN, LPN, LCSW, LMHC) preferred
• Minimum of three years' experience in a psychiatric or chemical dependency setting
• At least three years of Utilization Review experience preferred
• State licensure preferred (e.g., RN, LPN, LCSW, LMHC)