Utilization Management Clinical Reviewer

Behavioral Health Tech, Inc.; California (MO); Remote; USD 60,000 - 100,000; Full time

Job summary

An innovative firm is seeking a Utilization Management Clinical Reviewer to join their dedicated team. In this role, you will be responsible for reviewing patient charts and making recommendations for authorization extensions based on established medical necessity criteria. This position is crucial for ensuring that patients receive the care they need while adhering to internal policies. If you are passionate about mental health and thrive in a dynamic environment where your analytical skills can shine, this opportunity is perfect for you. Join a company that values diversity and inclusion, and make a meaningful impact in the lives of those with eating disorders.

Benefits

Flex PTO

Generous parental leave

Medical, Dental, and Vision plans

Company-paid Short-Term and Long-Term Disability

401(k) retirement plan

$50/month home internet stipend

Work from home stipend up to $500

Qualifications

• Must have independent mental health clinical licensure.
• Experience with behavioral health documentation and EMR systems required.

Responsibilities

• Manage reviews for extended authorization of cases.
• Make recommendations based on internal policies and medical necessity.
• Coordinate internal appeals with leadership.

Skills

Independent mental health clinical licensure

Behavioral health documentation review

EMR systems knowledge

Strong writing ability

Time management skills

Professional communication skills

Decision-making under ambiguity

HIPAA compliance knowledge

Education

Independent mental health clinical licensure (LCSW, LPC, LPCC, LMFT)

Tools

EMR systems

Job description

About Equip

Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, Equip builds upon evidence-based treatments to empower individuals to reach lasting recovery. All Equip patients receive a dedicated care team, including a therapist, dietitian, physician, and peer and family mentor. The company operates in all 50 states and is partnered with most major health insurance plans. Learn more about our strong outcomes and treatment approach at www.equip.health.

Founded in 2019, Equip has been a fully virtual company since its inception and is proud of the highly-engaged, passionate, and diverse Equisters that have created Equip’s culture. Recognized by Time as one of the most influential companies of 2023, along with awards from Linkedin and Lattice, we are grateful to Equipsters for building a sustainable treatment program that has served thousands of patients and families.

About the role

Reporting to the Director of Utilization Management (UM), the Utilization Management Clinical Reviewer will be responsible for completing chart-based reviews for potential authorization extensions beyond Equip’s standard length of stay, coordinating internal appeals, and monitoring utilization trends. This role requires the ability to independently analyze patient charts and make recommendations for extended authorization based on internal policies and medical necessity criteria. This role is payor and internal facing only and is not a good fit for someone looking to provide direct patient care.

Responsibilities

• Independently manage review of cases being considered for extended authorization.
• Apply internal policies and medical necessity criteria to individual cases.
• Make recommendations for extending authorization.
• Complete reviews according to Equip’s utilization management turnaround times and expectations.
• Collaborate with the Director of UM on complex cases and utilization trends.
• Coordinate internal appeals with the Director of UM and Medical and Psychiatric leadership.
• Maintain strong boundaries regarding fair, consistent application of internal policies across caseload.
• Perform other duties as assigned.

Qualifications

• Independent mental health clinical licensure (e.g. LCSW, LPC, LPCC, or LMFT).
• Experience with reviewing behavioral health documentation and familiarity with medical necessity criteria.
• Knowledge and experience with EMR systems required.
• Exceptionally strong writing ability, organization, and time management skills.
• Strong, professional communication and interpersonal skills.
• Comfortable with ambiguity with the ability to make decisions and recommendations while systems and processes are still being shaped.
• Familiarity with HIPAA privacy requirements for patient information. Ability to maintain and protect confidential information.
• Excellent organizational awareness, adaptability, and conflict management skills.
• A passion for living Equip’s mission and values.

Time Off:

• Flex PTO (3-5 wks/year recommended) + 11 paid company holidays.
• Generous parental leave.

Core Benefits:

• Competitive Medical, Dental, and Vision plans with generous employer contributions for both individuals and families.
• Company-paid Short-Term Disability, Long-Term Disability, Life and AD&D insurance.
• Company-paid partnership with Maven Clinic to provide comprehensive reproductive and family care resources.
• Employee Assistance Program (EAP), a company-paid resource for mental health, legal services, financial support, and more!
• 401(k) retirement plan.

Additional Perks:

• $50/month home internet stipend.
• One-time work from home stipend of up to $500.

Physical Demands

Work is performed 100% from home with no requirement to travel. This is a stationary position that requires the ability to operate standard office equipment and keyboards as well as to talk or hear by telephone. Sit or stand as needed.

At Equip, Diversity, Equity, Inclusion and Belonging (DEIB) are woven into everything we do. At the heart of Equip’s mission is a relentless dedication to making sure that everyone with an eating disorder has access to care that works regardless of race, gender, sexuality, ability, weight, socio-economic status, and any marginalized identity. We also strive toward our providers and corporate team reflecting that same dedication both in bringing in and retaining talented employees from all backgrounds and identities. We have an Equip DEIB council, Equip For All; also referred to as EFA. EFA at Equip aims to be a space driven by mutual respect, and thoughtful, effective communication strategy - enabling full participation of members who identify as marginalized or under-represented and allies, amplifying diverse voices, creating opportunities for advocacy and contributing to the advancement of diversity, equity, inclusion, and belonging at Equip.

As an equal opportunity employer, we provide equal opportunity in all aspects of employment, including recruiting, hiring, compensation, training and promotion, termination, and any other terms and conditions of employment without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, gender expression, familial status, age, disability, weight, and/or any other legally protected classification protected by federal, state, or local law.