Utilization Management Clinical Reviewer - Remote

Overview

The Utilization Management Clinical Reviewer at Equip is responsible for conducting chart-based reviews for authorization extensions, analyzing patient charts, and making recommendations based on internal policies and medical necessity criteria. This role does not involve direct patient care.

In Short

• Manage reviews for cases seeking extended authorization.
• Apply internal policies and medical necessity criteria.
• Make recommendations for extending authorization.
• Complete reviews according to turnaround times.
• Collaborate with the Director of UM on complex cases.
• Coordinate internal appeals.
• Maintain application of internal policies consistently.
• Perform other assigned duties.

Requirements

• Independent mental health clinical licensure (e.g. LCSW, LPC).
• Experience in reviewing behavioral health documentation.
• Knowledge of EMR systems is required.
• Strong writing, organization, and time management skills.
• Professional communication and interpersonal skills.
• Ability to make decisions amid ambiguity.
• Familiarity with HIPAA privacy requirements.
• Excellent organizational awareness and adaptability.
• Passion for Equip's mission and values.

Benefits

• Flex PTO (3-5 weeks/year) + 11 paid holidays.
• Generous parental leave.
• Competitive medical, dental, and vision plans.
• Company-paid disability and life insurance.
• Partnership with Maven Clinic for family care resources.
• Employee Assistance Program (EAP).
• 401(k) retirement plan.
• $50/month home internet stipend.
• One-time work from home stipend of up to $500.