Remote Utilization Review Specialist - Behavioral Health

The Florida House; United States; À distance; USD 65 000 - 90 000; Plein temps

Avantages offerts par ce poste

Health insurance

401(k)

PTO & Vacation

Employee Assistance Program

Growth opportunities

Free CEUs

Free CPR certification

CPI certification

Résumé du poste

FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued-stay authorizations, preventing denials, and aligning documentation with payer guidelines.

The role emphasizes reimbursement optimization, compliance, and high-quality patient care across behavioral health services.

Qualifications

• 2–3 years of utilization review experience in behavioral health or managed care.
• Strong understanding of ASAM criteria and DSM-5 documentation requirements.
• Excellent clinical summarization and documentation review skills.
• Ability to work with clinical teams and insurance reviewers under deadlines.

Responsabilités

• Manage all clinical authorization processes to ensure timely, accurate payer communication.
• Support patient access to treatment by securing initial and continued-stay authorizations.
• Collaborate with clinical teams to ensure medical necessity reflects payer guidelines.

Connaissances

Attention to detail

Time management

Communication with clinical teams

Formation

Bachelor’s Degree in Nursing, Social Work, Behavioral Health or related field

Description du poste

FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued-stay authorizations, preventing denials, and aligning documentation with payer guidelines.

The role emphasizes reimbursement optimization, compliance, and high-quality patient care across behavioral health services.