Utilization Review Specialist

Job Summary

Seeking an experienced and detail-driven Utilization Review Specialist, the full-time remote position will manage a caseload of 50-75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a liaison between clinical operations and managed care organizations.

Key Responsibilities

• Manage a caseload of 50-75 patients, authorizing 15-25 cases daily while ensuring timely utilization reviews and appropriate level of care determinations
• Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards
• Verify insurance benefits, coordinate authorizations, and effectively communicate with external case managers and managed care organizations

Required Qualifications

• High school diploma or equivalent
• Minimum one year of utilization review experience in a psychiatric or chemical dependency setting
• Strong organizational, documentation, and communication skills
• Ability to manage high caseloads with accuracy and efficiency
• Comfortable working independently in a remote environment