Remote Utilization Review Specialist, Behavioral Health

Gosnold; Wareham (MA); Remote; USD 60,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Flexible spending accounts

Paid vacation

Sick time

Holiday time

403b or 401k match

Life insurance

Critical illness insurance

Accident insurance

Employee Assistance Program

Tuition assistance

Job summary

Gosnold in Wareham, MA seeks a Utilization Review Specialist for a remote, full-time role (40 hours, 8a-4p). The position focuses on pre-certification and concurrent clinical utilization reviews with insurers, ensuring patient coverage and collaboration with Patient Financial Services.

Candidates should have a bachelor’s degree in nursing, social work, psychology, mental health or addiction, plus two years of clinical experience and knowledge of clinical criteria for levels of care.

Qualifications

• Bachelor’s degree in nursing, social work, psychology, mental health or addiction is required.
• Two years of clinical experience in utilization review or delivery of health services is preferred.
• Knowledge of clinical criteria for levels of care.
• Computer literacy and ability to learn behavioral health software programs; good communication and interpersonal skills.

Responsibilities

• Review pre-certification and concurrent utilization reviews with insurers.
• Coordinate recommendations with clinical staff for intervention strategies and authorizations.
• Provide technical assistance to staff on care coordination activities.
• Prepare and present cases for physician reviews as needed.
• Document authorizations and UR results in the system; report progress to treatment teams.

Skills

Computer literacy

Communication skills

Interpersonal skills

Organizational skills

Education

Bachelor’s degree in nursing, social work, psychology, mental health or addiction

Tools

Behavioral health software

Job description

Gosnold in Wareham, MA seeks a Utilization Review Specialist for a remote, full-time role (40 hours, 8a-4p). The position focuses on pre-certification and concurrent clinical utilization reviews with insurers, ensuring patient coverage and collaboration with Patient Financial Services.

Candidates should have a bachelor’s degree in nursing, social work, psychology, mental health or addiction, plus two years of clinical experience and knowledge of clinical criteria for levels of care.