Utilization Management Specialist II
Core
Coordinate and validate service authorization requests for behavioral health and intellectual/developmental disability populations to ensure clinical review workflows are accurate and timely.
Role type
Utilization Management Specialist
Builds
Service authorization determinations and clinical review workflows
Domain
Behavioral health / Intellectual and developmental disabilities
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Service authorization validation, documentation completeness checks, provider coordination, workflow routing, timeline monitoring, status tracking
Preferred skills
Medical terminology familiarity, healthcare documentation experience
Responsibilities
Review and validate service authorization requests against benefit requirements, check requests for completeness and accuracy, identify missing or inconsistent information and coordinate with providers, route complete requests to clinical reviewers, monitor authorization timelines, track authorization determinations
Seniority
Mid-level, hands-on IC