Utilization Review Specialist - LPN Required

Medusind; Costa Mesa, Northern (CA, KY); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Medusind in Costa Mesa, CA is seeking an UR Representative to conduct Utilization Reviews ensuring proper authorization for behavioral health services. You will review cases across multiple platforms, coordinate peer reviews, and enter authorization data while maintaining clear communication with facilities.

The role requires strong knowledge of levels of care, prior authorization processes, and behavioral health policies to support compliant, timely authorizations and effective coordination

Qualifications

• Experience conducting Utilization Reviews for behavioral health services.
• Familiarity with levels of care and prior authorization processes.
• Understanding of behavioral health policies and guidelines.

Responsibilities

• Conduct Utilization Reviews to determine appropriate authorizations.
• Review cases across multiple platforms and coordinate peer reviews.
• Enter and maintain authorization data and follow up on approvals.
• Maintain clear communication with facilities throughout the process.

Skills

Utilization Review

Behavioral health

Prior authorization

Communication with facilities

Job description

Position Overview:

The UR Representative is responsible for conducting Utilization Reviews (UR) to ensure appropriate authorization for behavioral health services. This role involves reviewing cases via multiple platforms, coordinating peer reviews, entering authorization data, following up on approvals, and maintaining clear communication with facilities. Strong knowledge of levels of care, prior authorization processes, and behavioral health policies is required.