Utilization Review Specialist

Job Summary

To support the treatment of addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews, collaborating with case managers and the multidisciplinary treatment team to ensure compliance with insurance requirements.

Key responsibilities

• Completes pre-authorizations, concurrent reviews, and internal utilization reviews
• Consults with the treatment team to gather necessary information for concurrent reviews
• Schedules peer-to-peer reviews and coordinates urgent appeals as needed

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
• Minimum of three years' experience in Utilization Review preferred
• State licensure preferred (e.g., RN, LPN, LCSW, LMHC)