Utilization Review Specialist

About the position

The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the best possible length of stays for our patients. Given the complex nature of insurance these days, it is crucial to have timely communication with these payors so that families can focus on what’s important, getting their loved ones the care they need. Our team is comprised of passionate, forward-thinking professionals eager to take on the challenge of the mental health crisis and play a formative role in providing life-saving solutions. We are looking for a candidate who is inspired by our mission and excited by the opportunity to build a business that will impact millions of lives in a profound way.

Responsibilities

• Oversees all functions of a virtual IOP caseload
• Completes peer reviews on cases with insurance
• Collaborates at a high level to problem solve on complex cases with Manager
• Completes pre-certs and continued stay authorizations for virtual IOP clients in a timely manner
• Follows up on all outstanding authorizations and reports all barriers to Manager
• Collaborates with Revenue Team and Admissions to improve patient experience from the front door through discharge
• Partners with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems
• Delivers frequent training to clinical teams for high quality documentation standardization
• Consulting across teams, providing mentorship, and contributing specialized knowledge

Requirements

• Master’s Degree in healthcare field preferred
• 2+ years of experience in a utilization role within the healthcare field required
• Microsoft Office and Salesforce proficiency
• Strong interpersonal, relationship-building and listening skills, with a natural, consultative style
• Ability to energize, communicate, and build rapport at all levels within an organization
• Strong project management skills, with a demonstrable ability to corral and manage details in a fast-paced, fluid environment
• Experience advising, presenting to, and persuading senior corporate personnel
• Knowledge of all confidentially requirements regarding patients and strict maintenance of proper confidentiality on all such information.
• Excellent written and verbal communication skills
• Organizational skills
• Ability to maintain a high level of integrity and confidentiality of medical information
• Strict attention to details

Benefits

• Comprehensive benefits to all full-time, exempt employees
• Target performance-based bonus
• Stock options and other Charlie Health-sponsored benefits