Utilization Review Specialist

Odyssey House; United States; Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Tuition assistance (9k/yr)

24/7 EAP

Paid continuing education

Monthly incentives

Flexible scheduling

Health insurance (medical, dental, vis

403(b) retirement plan 100% match up

35 paid days off

Sabbatical program

On-Demand Pay

Commute benefits

Job summary

Odyssey House is seeking a Full-Time Utilization Review Specialist to support medical necessity reviews, documentation, and coordination with billing and staff. The role emphasizes thorough UR processes, training, and timely submissions.

The ideal candidate will hold a licensed mental health credential, a graduate degree in the field, and be capable of navigating ASAM and DSM-V standards for authorizations. Flexible shifts and comprehensive benefits accompany this position.

Qualifications

• Licensed Mental Health Professional (CSW, LCSW, CMHC, ACHMC, LMFT, MFTI)
• Graduate degree in the mental health field
• Willingness to pass a criminal background check
• First Aid and CPR Certification (available at Odyssey House)
• Annual TB tests and Flu immunization as required
• Must be eligible for employment and able to work variable shifts

Responsibilities

• Track UR/CE/Insurance due dates and ensure timely submissions
• Review UR submissions for medical necessity and resubmit as needed
• Provide ongoing staff training on medical necessity and UR issues
• Resolve funding denials through UR modification and resubmission
• Update Best Notes and UWITS to reflect authorized days
• Generate reports with due dates and monitor staff progress
• Complete monthly Medicaid checks and upload snapshots
• Coordinate doc-to-doc calls for insurance authorization
• Communicate with billing department to resolve issues
• Perform duties timely, thoroughly, and professionally
• Demonstrate fluency in ASAM and DSM-V during authorization

Skills

ASAM knowledge

DSM-V knowledge

Communication skills

Team collaboration

Education

Licensed Mental Health Professional

Graduate degree in mental health field

Job description

Odyssey House is looking for a Full-Time Utilization Review Specialist.

Summary:

Odyssey House's Mission is "Empowering people to heal and build better lives. We are dedicated to helping individuals and families reclaim their lives through effective substance use treatment, medical care, prevention, and mental health services. Odyssey House continues to receive Best of State awards for our clinical work and has received Top Workplace Awards. Join our amazing team of healthcare professionals today!"

Full-Time Benefits:

• $9k per year tuition eligible
• Access to 24/7 EAP program (Employee Assistance Program) for Mental Health support and more!
• Opportunities for paid continuing education/training
• Monthly incentives and awards
• Flexible scheduling
• Casual dress and atmosphere
• Opportunities for bonuses, awards, raises, and promotions
• Incredible health insurance (medical, dental, vision, FSA, long and short-term disability)
• Immediate eligibility to participate in our 403(b)-retirement plan, Employer 100% match up to 5% after 1 year
• 35 paid days off (additional PTO accrual after 1 year)
• EXTRA time off and gift packages for PT and FT staff that stay more than 90 days!
• Sabbatical Program - where we pay you to take a vacation after 5 years of service!
• On-Demand Pay - Get a portion of your paycheck early for hours already worked! (conditions apply)
• UTA free passes available for your work commute

Functions of the Job:

• Track UCE/UR/Insurance Due Dates for all funding and ensure timely submission of all requests.
• Review all UR submissions for medical necessity, make corrections to UR, and submit for approval.
• Provide ongoing training to staff regarding writing to medical necessity or other issues that present during reviewing UMs.
• Resolve funding denials through immediate UR modification and resubmission to minimize loss of days.
• Update Best Notes and UWITS, as needed, to reflect authorized days.
• Generate Reports with due dates, notify staff of changes, and manage staff progress.
• Complete monthly Medicaid check (upload snapshots to Best Notes.)
• Complete “doc-to-doc” calls, as needed, for insurance authorization.
• Communicate with OH billing department to resolve issues.
• Complete all responsibilities in a timely, thorough, and professional manner.
• Demonstrate fluency in ASAM and DSM-V through successful authorization and processing of UMs.
• Other Duties as assigned.

Requirements

Licensure / Education / Prior Experience Required:

• Licensed Mental Health Professional, including - CSW, LCSW, CMHC, ACHMC, LMFT, MFTI.
• Graduate degree in the mental health field.
• Willingness and ability to pass a criminal background check
• First Aid and CPR Certification (available at Odyssey House)
• Must comply with annual TB tests and Flu immunization (and other immunizations as needed)
• Must meet employment eligibility
• Must be able to work variable shifts as needed

All employees of Odyssey House are required to adhere to: Odyssey House mission, philosophy, and scope of service; Division of Human Services Code of Conduct and all other relevant service contract requirement standards; ensuring a safe environment for all clients and staff; providing exemplary customer service to both internal and external customers; fostering a positive work environment; ensuring high-quality client care within the scope of the assigned position.

Each employee is expected to clearly understand roles and responsibilities regarding the following: Specific job positions, time management, personnel file requirements, client record system, incident reporting, mandatory training requirements, maintaining proper client boundaries, and individual rights of clients and staff.

Physical Demands of the Job:

Ability to lift up to 15 lbs., drive (or adequate alternate transportation), sit for prolonged periods, and perform light to moderate physical activity at times. Able to passively restrain residents without likely injury to self due to existing medical condition.

EEOC Statement:

Odyssey House is an equal-opportunity employer. All aspects of employment, including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We do not discriminate based on race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.