Remote Utilization Review Specialist

Northpoint Recovery; Meridian, Northern (ID, KY); Hybrid; USD 41,000 - 48,000; Full time

Benefits offered by this job

Health insurance

Life insurance

Employee assistance program

Dental

Vision

Short-term disability

Supplemental life

Pre-tax savings accounts

Paid time off

Job summary

Northpoint Recovery is seeking an experienced Utilization Review Specialist for a remote, full-time role. You will ensure clinically appropriate care and cost-effective utilization across the treatment continuum, collaborating with payers and the care team from admission to discharge.

Qualified candidates hold a master’s degree or commensurate experience, possess active licensure in behavioral health, and have 1+ year of relevant experience. Strong communication and confidentiality are essential.

Qualifications

• Master’s Degree in Social Sciences or commensurate experience.
• Must hold an active substance abuse or mental health licensure in the state where treatment services are rendered.
• Must maintain applicable state licensure requirements at hire, and for the entire duration of employment.
• 1+ year of experience in relevant field required.
• Must be able to exercise discretion and independent judgment in all areas of job performance including adherence to appropriate professional boundaries and strict confidentiality practices in regard to client activities and documentation.
• Able to apply clinical judgment, ethics and accountability to formulate and implement treatment plans and other clinical documentation.
• Must hold strong personal boundaries and able to build rapport with patients and staff.
• Must understand and adhere to the ethical standards of the respective licensure governing board.

Responsibilities

• Apply utilization criteria to monitor admissions and levels of care.
• Communicate with payers for initial and concurrent reviews.
• Review charts to confirm continued medical necessity.
• Document actions and share information with care teams.
• Escalate cases not meeting medical necessity to management.
• Refer cases exceeding LOS or costs to leadership.
• Conduct verbal/fax reviews with payers as needed.
• Collect data on LOS variances, costs, and barriers.
• Prepare appeals for denied cases when appropriate.
• Communicate clearly with patients and families and staff.
• Maintain knowledge of disease processes and utilization review.
• Apply nationally recognized criteria for medical necessity.
• Adhere to all policies and maintain confidentiality.
• Perform other duties as assigned.

Skills

Clinical judgment

Confidentiality

Rapport building

Communication

Ethics

Education

Master’s Degree in Social Sciences or commensurate experience

Tools

Microsoft Office

Job description

Northpoint Recovery is seeking an experienced Utilization Review Specialist for a remote, full-time role. You will ensure clinically appropriate care and cost-effective utilization across the treatment continuum, collaborating with payers and the care team from admission to discharge.

Qualified candidates hold a master’s degree or commensurate experience, possess active licensure in behavioral health, and have 1+ year of relevant experience. Strong communication and confidentiality are essential.