Remote Utilization Review Specialist - Behavioral Health

Hansei Solutions; Franklin (TN); Remote; USD 52,000 - 70,000; Full time

Benefits offered by this job

Remote‑first culture

Competitive salary

Health insurance

401(k) plan with employer match

Paid time off and holidays

Professional development

Great place to work

Job summary

Hansei Solutions is seeking an Utilization Review Specialist to act as the vital link between insurance payors and treatment facilities, advocating for clients to secure maximum authorized treatment days. The role emphasizes communication, organization, data entry, multitasking, and advocacy.

You will collaborate with clinical staff to optimize authorization decisions, manage caseloads, and ensure accurate documentation while staying compliant with HIPAA regulations.

Qualifications

• 2+ years of experience in the behavioral health field.
• Preferred clinical licenses (LMFT, LCDC, LiCSW) or nursing degree (MSN, RN, LVN), or 2 years UR experience.
• 2 years of sobriety if personally represented as "recovering".

Responsibilities

• Serve as liaison between client/facility and their respective insurance carrier.
• Manage caseloads through initial analysis, concurrent review, collaboration, and consultation to obtain maximum reimbursement.
• Establish patients’ current insurance information.
• Communicate with VOB team to ensure up-to-date verification of benefits for every case.
• Assist admission by participation in the pre-certification process.
• Collect and provide initial and concurrent reviews of patients’ clinical status for insurance companies based on initial and continued stay care criteria.
• Notify attending physician and care team of recommendations for continued treatment based on medical necessity.
• Collaborate with the treatment team to maximize treatment days for each client.
• Assist discharge planning, referrals, and crisis intervention.
• Stay up to date with clients’ charts to relay accurate information to insurance carriers.
• Submit data to identify patterns of intervention resulting in desired patient outcomes.
• Complete all insurance and review documentation promptly.
• Facilitate all insurance reviews with UR department on time.
• Observe confidentiality of patient information and HIPAA regulations.
• Attend mandatory in-services and staff meetings.
• Participate in professional, continuing education and keep attendance records.
• Identify performance improvement opportunities and participate in quality improvement endeavors.

Skills

Insurance knowledge

Treatment center ops

MS Office

Communication skills

HIPAA compliance

EMR experience

Data entry

Education

2+ years behavioral health experience

Tools

Kipu EMR

Best Notes

Alleva

Medical Mime

Job description

Hansei Solutions is seeking an Utilization Review Specialist to act as the vital link between insurance payors and treatment facilities, advocating for clients to secure maximum authorized treatment days. The role emphasizes communication, organization, data entry, multitasking, and advocacy.

You will collaborate with clinical staff to optimize authorization decisions, manage caseloads, and ensure accurate documentation while staying compliant with HIPAA regulations.