Utilization Review Coordinator

Job Summary

Detail-oriented and knowledgeable, the full-time remote Utilization Review Coordinator will manage client insurance authorization processes for Spravato and TMS services, ensuring timely submission of clinical documentation and coordinating with various teams to maintain compliance with payer guidelines.

Key responsibilities

• Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plans
• Ensure timely submission of required clinical documentation, including medical necessity letters and treatment plans
• Coordinate with providers, clinical staff, and billing teams to ensure complete and accurate information is submitted

Required qualifications

• Minimum 2 years of experience in medical prior authorization, utilization review, or billing, preferably in behavioral health or neuromodulation
• Strong working knowledge of medical necessity criteria for Spravato and TMS services, including familiarity with CMS and payer guidelines
• Experience with a wide range of insurance carriers, including Massachusetts and Rhode Island-specific carriers
• Preferred experience with in-network and out-of-network authorization workflows
• Comfortable working with EHR systems, payer portals, and medical documentation