Senior Utilization Review Specialist

Compass Health Center; United States; On-site; USD 57,000 - 62,000; Full time

Job summary

Join a forward-thinking organization dedicated to mental health care, where you will play a crucial role as a Utilization Review Specialist. You'll advocate for patients, ensuring they receive the necessary care without insurance barriers. Collaborate with clinical teams to secure authorizations and navigate the complexities of insurance, all while maintaining strong relationships with payors. This role is perfect for those who thrive in a fast-paced environment and are passionate about patient advocacy. Be part of a mission-driven team that values cultural humility and continuous improvement, making a real difference in the lives of patients.

Benefits

Comprehensive medical/dental/vision plans

401k program with company matching

Generous PTO

Competitive parental leave

Continuous training through CEU seminars

Volunteering opportunities

Qualifications

• Proven ability to collaborate across teams and departments.
• Organized and detail-oriented with healthcare experience.

Responsibilities

• Serve as the primary patient advocate with insurance.
• Lead initial reviews with out-of-network insurance companies.

Skills

Patient Advocacy

Insurance Navigation

Collaboration

Detail-Oriented

Education

Bachelor's Degree

Relevant Experience

Job description

Weekly outpatient therapy isn't always enough, and a trip to the ER isn't the only answer. Patients and their families rely on CompassHealth Center whenincrisis – every day, wehelp people overcome depression, anxiety, suicidality, obsessions/compulsions, trauma, chronic pain, and other obstacles in order for our patients to live freely.

About This Role

As a Utilization Review Specialist focused on Single Case Agreements and Out-of-Network coverage (SCA/OON), you’ll be a vital advocate ensuring patients can access the care they need, regardless of insurance barriers. You’ll take the lead in securing prior authorizations and pre-certifications for mental health partial hospitalization and intensive outpatient services, ideally before or right as a patient begins care. Partnering closely with our clinical, intake, and patient advocacy teams, you’ll navigate insurance conversations with confidence, build strong relationships with payors, and ensure approvals are in place so treatment can start without delay. From initiating reviews to managing appeals, you'll play a key role in making sure patients receive timely, covered care. If you're passionate about patient advocacy and thrive in a fast-paced, collaborative environment, we’d love to have you on our team.

What You’ll Do:

• Serve as the primary patient advocate with insurance
• Take the lead on all initial reviews with out-of-network insurance companies for pre-certification
• Seek the approval of single case agreements and/or out of network exceptions
• Collaborating with the intake therapist and patient advocate to collect all relevant and up to date clinical and benefit information for patients
• Provide the best presentation or rationale for patient to receive out of network partial or intensive outpatient treatment on an in-network basis
• Complete all levels of appeals available (pre-certification and concurrent)
• Build and maintain strong relationships with case managers
• Work closely with designees from payor contracting and patient advocate team to increase likelihood of successfully obtaining single case agreements and/or an out of network exception
• Accurately documenting approval for and authorization fordays of treatment in program
• Communicating treatment approvals and schedule additional reviews as needed
• Abide by HIPAA compliance standards
  
  

Who You Are:

• Proven ability to collaborate across teams and departments
• Are able to relay detailed patient information in a compassionate and confidential manner
• Are organized and detail-oriented
• Enjoy a fast-paced, collaborative environment
• Bachelor's Degree or relevant experience
• Previous healthcare or insurance experience required
  
  

We are committed to a fair and equitable work environment. The expected compensation range for this role is below. This range includes multiple career path levels across the organization; where you fall in the range is dependent upon a number of factors including, but not limited to, your years of experience, type of experience, location, and education/certifications. Compass reserves the right to update these ranges.

Compensation

$57,000—$62,000 USD

We know job descriptions can be intimidating, so if this sounds like an opportunity for you, please don't hesitate to apply!

Who We Are

Compass Health Center is a recognized leader in crisis-level mental health, bringing passion, connection, and patient-centered care to the PartialHospitalizationand Intensive Outpatient space (PHP/IOP). Based in Chicagoland, we serve hundreds of patients every day, ranging from ages 5 through adulthood, in our onsite facilities or through our flourishing virtual programming.Compass fills a critical gap between outpatient and inpatient care through an intermediate level of Behavioral Healthcare.

A few more things we want you to know: our values are super important to us, and hopefully will be to you, too. Cultural humility, teamwork, continuous improvement, connection, patient centered care, passion, innovation, and agility should be your power sources. Joining Compass is an opportunity to feel fulfilled through a joint mission towards healing our communities.

Benefits & Perks

We know that you will be dedicated to your purpose here. We look at that investment as a two-way street. We are proud to offer plenty of space for growth, and opportunities to pursue continuous development within our organization.

For eligible positions, our other benefits include: comprehensive medical/dental/vision plans, 401k program with company matching, generous PTO (including competitive parental leave after 1 year of employment), and continuous training through CEU seminars and volunteering opportunities.

What’s Next?

Compass is committed to cultivating diverse and dynamic teams who exude passion for their craft, so whether or not you check all the boxes, we encourage you to apply – we’d be grateful to hear from you!

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  Mental Health Care

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