Remote Utilization Review Specialist – Behavioral Health

NurseRemotely; United States; Remote; USD 40,000 - 50,000; Part time

Job summary

Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams.

The ideal candidate has prior utilization review or behavioral health experience, strong knowledge of payer requirements, excellent communication, and the ability to work weekends as needed.

Qualifications

• Experience in Utilization Review or Managed Care in healthcare.
• Experience with behavioral health treatment programs preferred.
• Strong knowledge of insurance authorization processes and reimbursement practices.

Responsibilities

• Conduct utilization reviews for admissions and continued stays to establish medical necessity.
• Review clinical documentation to support level of care and length of stay.
• Present clinical information to insurers to obtain or extend authorizations.
• Communicate with insurance case managers regarding benefits and status.
• Collaborate with clinical staff to ensure payer requirements are met.
• Provide guidance on insurance criteria, stay requirements, and discharge planning.
• Maintain accurate, timely documentation per policies and regulatory standards.
• Protect patient confidentiality and HIPAA compliance.
• Work with multidisciplinary teams to support patient care and reimbursement.
• Perform other duties as assigned.

Skills

Utilization Review

Managed Care

Behavioral Health

Insurance Authorizations

Communication Skills

Organizational Skills

Tools

EMR Systems

Microsoft Office

Job description

Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams.

The ideal candidate has prior utilization review or behavioral health experience, strong knowledge of payer requirements, excellent communication, and the ability to work weekends as needed.