Utilization Review Specialist - PHP

Job Summary

A company is looking for a Utilization Review Specialist for a Partial Hospitalization Program (Remote).

Key Responsibilities

• Conduct comprehensive reviews of patient records to ensure appropriate service utilization and compliance with insurance requirements
• Collaborate with clinical teams, insurance companies, and billing departments to facilitate transitions of care and ensure accurate documentation
• Promote quality patient outcomes while managing resource efficiency

Required Qualifications, Training, and Education

• Bachelor's degree in nursing, social work, or a related healthcare field required; licensure preferred (e.g., RN, LCSW, LMFT)
• Master level clinician (MSN, MSW, etc.) preferred
• Minimum of 2 years' experience in a behavioral health setting, preferably in utilization review or partial hospitalization programs
• Strong knowledge of payer regulations and medical necessity criteria
• Experience in utilization management processes is preferred