Utilization Review Specialist

Charlie Health, Inc.; United States; Remote; USD 62,000 - 70,000; Full time

Benefits offered by this job

Stock options

Benefits package

Bonus program

Job summary

Charlie Health is seeking a skilled utilization specialist to ensure efficient, thorough authorization flows for virtual IOP programs.

You will drive pre-certs, peer reviews, and denials support, coordinating with care teams and Revenue Cycle to enhance care access and efficiency.

Qualifications

• Active, Unrestricted Professional License in the U.S. state or territory.
• 2+ years in a utilization role within behavioral health.
• Familiarity with HIPAA and patient confidentiality requirements.
• Knowledge of utilization review processes and medical necessity criteria.
• Experience with InterQual, MCG or similar guidelines.

Responsibilities

• Oversee all functions of a virtual IOP caseload.
• Collaborate with Manager to solve complex cases.
• Complete pre-certs and authorizations for virtual IOP clients timely.
• Conduct peer-to-peer reviews with insurance MDs for approvals after denials.
• Follow up on outstanding authorizations and report barriers.
• Collaborate with Revenue Cycle and Admissions to improve patient experience.
• Provide training to clinical teams for documentation standards.
• Participate in denial management and appeals processes.

Skills

Utilization management

EMR systems

HIPAA compliance

InterQual/MCG familiarity

Communication skills

Project management

Education

MD/DO or PsyD/PhD or LCSW/LMFT/LCPC

Tools

EMR proficiency

Utilization management systems

Job description

Why Charlie Health?

Millions of people across the country are navigating mental health conditions, substance use disorders, and eating disorders, but too often, they’re met with barriers to care. From limited local options and long wait times to treatment that lacks personalization, behavioral healthcare can leave people feeling unseen and unsupported.

Charlie Health exists to change that. Our mission is to connect the world to life-saving behavioral health treatment. We deliver personalized, virtual care rooted in connection—between clients and clinicians, care teams, loved ones, and the communities that support them. By focusing on people with complex needs, we’re expanding access to meaningful care and driving better outcomes from the comfort of home.

As a rapidly growing organization, we’re reaching more communities every day and building a team that’s redefining what behavioral health treatment can look like. If you’re ready to use your skills to drive lasting change and help more people access the care they deserve, we’d love to meet you.

About the Role

The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the best possible length of stays for our patients. Given the complex nature of insurance these days, it is crucial to have timely communication with these payors so that families can focus on what’s important, getting their loved ones the care they need.

We’re a team of passionate, forward-thinking professionals eager to take on the challenge of the mental health crisis and play a formative role in providing life‑saving solutions. If you’re inspired by our mission and energized by the opportunity to increase access to mental healthcare and impact millions of lives in a profound way, apply today.

Responsibilities

• Oversees all functions of a virtual IOP caseload
• Collaborates at a high level to problem solve on complex cases with Manager
• Completes pre‑certs and authorizations for virtual IOP clients in a timely manner
• Completes peer to peer reviews with insurance MDs to advocate for treatment post first line denial outcomes.
• Follows up on all outstanding authorizations and reports all barriers to Manager
• Collaborates with Revenue Cycle Team and Admissions to improve patient experience from the front door through discharge Partners WithManager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems
• Delivers training to clinical teams for high quality documentation standardization
• Participate in denial management, appeals, and peer‑to‑peer review processes

Requirements

• Active, Unrestricted Professional License: You must hold a current, active, and unencumbered license to practice independently in a U.S. state or territory. Common credentials include:
  • Physicians: MD or DO (typically Board Certified in Psychiatry or Child/Adolescent Psychiatry).
  • Psychologists: PsyD or PhD (Licensed Psychologist).
  • Master’s-Level Clinicians: LCSW, LMFT, LPC, or LCPC.
• 2+ years of experience in a utilization role within the behavioral health field required
• Google proficiency
• Strong interpersonal, relationship-building and listening skills, with a natural, consultative style
• Ability to energize, communicate, and build rapport at all levels within an organization
• Strong project management skills, with a demonstrable ability to corral and manage details in a fast‑paced, fluid environment
• Experience advising, presenting to, and persuading senior corporate personnel
• Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations
• Familiarity with InterQual, MCG, or similar clinical guidelines
• Strong analytical, communication, and documentation skills
• Proficiency with electronic medical records (EMR) and utilization management systems
• Understanding of HIPAA and patient confidentiality requirements

Benefits

Charlie Health is pleased to offer comprehensive benefits to all full‑time, exempt employees. Read more about our benefits here.

The total target base compensation for this role will be between $62,000 and $70,000 per year at the commencement of employment. In addition to base compensation, this role also offers a performance bonus. The expected total cash compensation range, including potential bonus, will be between $0 and $900 per month. Please note, pay will be determined on an individualized basis and will be impacted by location, experience, expertise, internal pay equity, and other relevant business considerations. Further, cash compensation is only part of the total compensation package, which, depending on the position, may include stock options and other Charlie Health‑sponsored benefits. #LI-REMOTE

Please note that this role is not available to candidates inAlaska, Maine, Washington DC, New Jersey, California, New York, Massachusetts, Connecticut, Colorado, Washington State, Oregon, or Minnesota.

Our Values

• Connection: Care deeply & inspire hope.
• Congruence: Stay curious & heed the evidence.
• Commitment: Act with urgency & don’t give up.