Utilization Review Specialist: Care Access Compliance

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 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.