Remote Utilization Review Coordinator for Mental Health

Nrg-Mgmt-LLC; Boca Raton (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive salary

Health insurance

Vision and dental insurance

401(k) with company match

Paid time off and holidays

Continuing education opportunities

Job summary

Remedial Pro seeks a utilization review professional to monitor adherence to the facility’s utilization plan and ensure appropriate admissions and stays. You will handle initial and concurrent reviews, collaborating with insurers and healthcare partners to communicate plans of care and justify medical necessity.

The role requires experience in psychiatric/addiction care, strong confidentiality with HIPAA, and excellent communication and organizational skills.

Qualifications

• Bachelor's or Master’s degree in Behavioral/Mental Health Field or related experience preferred.
• 3–5 years of utilization review experience.
• Expertise in psychiatric and addiction disorders.
• HIPAA compliance and confidentiality experience.

Responsibilities

• Complete initial, concurrent, peer reviews and expedited appeals timely.
• Authorize treatment with insurance and managed care companies.
• Communicate plans of care to insurance case managers, facility staff, and partners.
• Collaborate with facilities to obtain clinical documentation for reviews.
• Ensure appropriate lengths of stay and resource utilization.
• Represent the company professionally per standards of conduct and protect patient privacy.

Skills

Utilization review

Psychiatric disorders

Addiction disorders

HIPAA compliance

Communication skills

Organizational skills

Time management

MS Office

Education

Bachelor's or Master's in Behavioral/Mental Health

Tools

Microsoft Office Suite

Job description

Remedial Pro seeks a utilization review professional to monitor adherence to the facility’s utilization plan and ensure appropriate admissions and stays. You will handle initial and concurrent reviews, collaborating with insurers and healthcare partners to communicate plans of care and justify medical necessity.

The role requires experience in psychiatric/addiction care, strong confidentiality with HIPAA, and excellent communication and organizational skills.