Utilization Review Specialist

Charlie Health

8h•Remote

About The Position

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.

Requirements

High School Diploma
2+ years of experience in a utilization role within the utilization review 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

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
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 with Manager 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