Utilization Review Specialist

2 hours, 28 minutes ago
Full-time
Mid Level
Customer and Technical Support
Remote Raven

Remote Raven

Remote Raven connects clients with highly qualified virtual assistants to quickly fill positions, enabling businesses to focus on core activities with no start-up fees.

Professional Services
11-50

Description

  • Manage and submit preauthorization requests for Residential, PHP, IOP, and Standard Outpatient levels of care.
  • Ensure documentation is complete, accurate, and aligned with clinical needs and insurance requirements.
  • Communicate with insurance providers to secure timely approvals and advocate for necessary services.
  • Negotiate, document, and manage Single Case Agreements for out-of-network services.
  • Monitor ongoing treatment needs and submit continued authorization requests to prevent lapses in coverage.
  • Work with clinical staff to gather progress notes, updated treatment plans, and other supporting documentation.
  • Attend regular meetings with clinical staff to review client progress, treatment plans, and authorization needs.
  • Develop and deliver training on medical necessity criteria and documentation standards for clinicians.
  • Provide feedback, resources, and ongoing support to improve clinical documentation practices.
  • Manage authorization denials, appeals, compliance tracking, recordkeeping, and reporting.

Requirements

  • Bachelor’s degree in healthcare administration, social work, or a related field preferred.
  • 3–5 years of experience in utilization review, medical billing, or a related field.
  • Behavioral health experience preferred.
  • Strong understanding of insurance authorization processes, including preauthorization, continued authorization, and Single Case Agreements.
  • Experience with multiple levels of care, including Residential, PHP, IOP, and OP.
  • Excellent communication and negotiation skills.
  • Proficiency in electronic medical records (EMR) systems and documentation standards.
  • Ability to collaborate with clinical staff and train others on complex topics.
  • Strong organizational skills and time-management abilities.
  • This is a full-time, 100% remote role.

Benefits

  • Up to $6/hour compensation.
  • 100% remote work.
  • Full-time employment.

Interested in this position?

Apply directly on the company website

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