Inpatient Utilization Review Specialist
About The Position
The Ascent Programs are licensed, accredited therapeutic programs located in Utah. We have 25+ years of experience using evidence-based practices to help families heal. As our Utilization Review Specialist, you will responsible for maintaining organizational compliance and following all HIPPA regulations while providing compassionate service. Position Overview The Utilization Review (UR) Specialist for Behavioral Health is responsible for managing medical necessity reviews, securing authorizations, and preventing denials for inpatient psychiatric and behavioral health services. This fully remote role requires strong clinical judgment, payor communication skills, and a working knowledge of behavioral health level-of-care criteria. The UR Specialist serves as the bridge between the treatment team and insurance providers, ensuring patients receive medically necessary care while protecting reimbursement and maintaining compliance.
Requirements
- Prior utilization review or case management experience in behavioral health
- Strong knowledge of behavioral health medical necessity criteria
- Able to pass background criminal investigation checks
- Eligible to work in the USA
- Proficient in basic computer programs
- Proficient in communicating, both verbally and in writing, in English
- Reflective listening skills
- Empathetic
- Clear, honest communication
Nice To Haves
- 1–3+ years of behavioral health inpatient or residential experience
- Experience working with commercial insurance, Medicaid MCOs, and Medicare
- Some college in Social Work or Psychology
- Professional experience in a treatment facility and/or Inpatient Psych Hospital (RTC, etc.)
- Small, close knit team
Responsibilities
- Apply medical necessity criteria using InterQual Behavioral Health, MCG Behavioral Health, or equivalent guidelines
- Identify appropriate level of care (acute inpatient, residential, PHP, IOP, etc.)
- Collaborate with clinical staff to obtain documentation supporting continued stay
- Submit initial authorization requests and complete concurrent reviews with commercial payors
- Coordinate peer-to-peer reviews when required
- Track authorization periods and proactively prevent gaps in coverage
- Escalate concerns regarding adverse determinations or limited day approvals
- Assist with drafting appeal letters and supporting documentation for denied days
- Monitor trends related to denials and collaborate with leadership to reduce financial risk
- Maintain HIPAA-compliant home office environment
- Reliable high-speed internet and ability to manage multiple payor portals
- Participate in virtual treatment team meetings and UR huddles
- Maintain productivity and quality metrics in a self-directed remote setting
Benefits
- Health, dental, vision, accident, critical illness, and other insurance plans available after probationary period for full-time employees
- Employer contributions to Health Savings Account (HSA)
- Free Employee Assistance Program (EAP)
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
