Utilization Review Specialist
Core
Ensure thorough and streamlined utilization processes to determine optimal length of stays for patients with complex behavioral health needs.
Role type
Utilization Review Specialist (Behavioral Health)
Builds
Virtual Intensive Outpatient Program (IOP) caseloads and authorization workflows
Domain
Behavioral Health / Mental Health / Insurance Utilization Management
Required skills
Utilization review processes, medical necessity criteria, healthcare regulations, InterQual/MCG guidelines, denial management, peer-to-peer reviews, EMR systems, HIPAA compliance
Preferred skills
Google proficiency, project management, senior corporate communication
Responsibilities
Oversee virtual IOP caseload functions, complete pre-certs and authorizations, conduct peer-to-peer reviews with insurance MDs, manage denial appeals, troubleshoot workflows for efficiency, deliver training on documentation standards
Seniority
Mid-level, hands-on IC