Utilization Review Specialist

About the role

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.

Responsibilities

• Oversees all functions of a virtual IOP caseload
• Collaborates at a high level to problem solve on complex cases with Manager
• Completes pre-certs and authorizations for virtual IOP clients in a timely manner
• Follows up on all outstanding authorizations and reports all barriers to Manager
• Collaborates with Revenue Cycle Team and Admissions to improve patient experience from the front door through discharge
• PARTNERS WITH MANAGER AND DIRECTOR TO TRICKLE DOWN WORKFLOWS AND PROCESSES TO ACHIEVE EFFICIENCY GAINS IN CURRENT AND FUTURE COMPANY SYSTEMS
• Delivers training to clinical teams for high quality documentation standardization
• Participate in denial management, appeals, and peer-to-peer review processes

Requirements

• A High School Diploma
• 2+ years of experience in a utilization role within the utilization review field required
• Google 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 utilization review processes, medical necessity criteria, and healthcare regulations
• Familiarity with InterQual, MCG, or similar clinical guidelines
• Strong analytical, communication, and documentation skills
• Proficiency with electronic medical records (EMR) and utilization management systems
• Understanding of HIPAA and patient confidentiality requirements

Benefits

Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here.

Pay

N/A

Schedule

N/A