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 while coordinating with various teams.

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 accurate information is submitted and track authorization requests and denials

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 commercial payer guidelines
• Experience with various insurance carriers, particularly Massachusetts and Rhode Island-specific carriers
• Comfortable working with EHR systems and payer portals
• Preferred experience with in-network and out-of-network authorization workflows