Remote Utilization Review Specialist — Clinical & Payer Liaison

Northpoint Recovery Holdings, LLC; Meridian (ID); On-site; USD 48,000 - 55,000; Full time

Benefits offered by this job

Health insurance

Life insurance

Employee assistance program

Dental insurance

Vision insurance

Disability insurance

Paid time off

Job summary

Northpoint Recovery Holdings, LLC is seeking a Remote Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will liaise with payers and the clinical team to manage admissions, continued stays, and appeals.

Applicants should hold a Master’s in Social Sciences or equivalent, with an active licensure in the treating state and at least 1 year of relevant experience.

Qualifications

• Master’s degree or commensurate experience in social sciences or related field.
• Active substance abuse or mental health licensure in the treatment state.
• 1+ year of relevant field experience.

Responsibilities

• Review admissions and levels of care for medical necessity.
• Communicate with payers for clinical reviews and appeals.
• Document actions and share with care teams and payers.
• Monitor LOS, costs, and resource utilization; escalate when needed.
• Perform clinical reviews and coordinate with multidisciplinary team.

Skills

Critical thinking

Excellent communication

Organizational abilities

Attention to detail

Multitasking

Discretion/confidentiality

Education

Master’s Degree in Social Sciences

Active substance abuse or mental health licensure

Tools

Microsoft Office Suite

Job description

Northpoint Recovery Holdings, LLC is seeking a Remote Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will liaise with payers and the clinical team to manage admissions, continued stays, and appeals.

Applicants should hold a Master’s in Social Sciences or equivalent, with an active licensure in the treating state and at least 1 year of relevant experience.