Utilization Reviewer - Behavioral Health Services - Remote

Overview

The Utilization Reviewer plays a crucial role in ensuring effective utilization review processes within Behavioral Health Services, advocating for patients and collaborating with clinical staff and insurance providers.

In Short

• PRN/As Needed position with weekday, daytime availability.
• Conducts utilization review calls including precertification and discharge reviews.
• Works closely with clinical staff and physicians.
• Communicates patient status and insurance information.
• Advocates for patients with insurance companies.
• Coordinates appeals for unfavorable utilization review decisions.
• Requires 2+ years of experience in relevant fields.
• Master's Degree in Social Work or Psychology preferred.
• Behavioral Health experience is a plus.
• Offers competitive benefits including tuition reimbursement.

Requirements

• 2+ years of experience in utilization review or related fields.
• Master's Degree in Social Work or Psychology or BSN with RN License.
• Familiarity with DSM diagnoses and ASAM criteria.
• Strong communication skills for patient advocacy.
• Ability to work collaboratively with clinical staff.

Benefits

• Competitive benefits including tuition reimbursement.
• Loan forgiveness programs.
• 401(k) matching.
• Lifecycle benefits for employee well-being.