Utilization Review Specialist
4 days ago
Job Title: Utilization Review Specialist – RemoteLocation: RemoteEmployment Type: Full-TimeSalary: Competitive, based on experience About Us We are a leading behavioral health organization dedicated to providing high-quality care. We are seeking a detail-oriented and proactive Utilization Review Specialist to manage insurance authorizations and support our clinical team. This remote role is ideal for professionals with strong knowledge of preauthorizations, continued authorizations, and Single Case Agreements (SCAs). What We Offer Fully remote position Full-time schedule Opportunity to work with a supportive and collaborative clinical team Key Responsibilities Preauthorization & Authorization Management Manage preauthorization requests for Residential, Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP), and Outpatient (OP) levels of care. Ensure all documentation accurately reflects client clinical needs. Communicate with insurance providers to secure timely approvals. Single Case Agreements (SCAs) Negotiate and manage SCAs for out-of-network client services. Ensure proper documentation and approvals are communicated to clinical and billing teams. Continued Authorizations Submit continued authorization requests to maintain uninterrupted client care. Collaborate with clinical staff to gather necessary documentation, including progress notes and updated treatment plans. Track authorization deadlines and proactively follow up to prevent coverage lapses. Clinical Staff Collaboration & Training Attend clinical meetings to discuss client progress and authorization needs. Provide feedback and training on documentation standards and medical necessity criteria. Develop resources to support clinical staff in meeting insurance documentation requirements. Client Advocacy & Compliance Act as liaison between clients, clinical teams, and insurance providers. Manage appeals for authorization denials with proper documentation. Maintain compliance with regulations and organizational standards. Generate reports on authorization success rates and areas for improvement. Minimum Qualifications Bachelor’s degree in healthcare administration, social work, or related field preferred. 3–5 years of experience in utilization review, medical billing, or a related field, preferably in behavioral health. Strong knowledge of insurance authorization processes and multiple levels of care. Excellent communication and negotiation skills. Proficiency in EMR systems and documentation standards. Detail-oriented with strong organizational and time-management skills. Physical & Work Requirements Ability to perform essential functions, including walking, standing, using office equipment, and driving as needed. May require occasional evening or weekend work based on clinical needs. How to Apply Send your application to with the subject line: JobStreet Applicant | Utilization Review Specialist | (Your Full Name) #J-18808-Ljbffr
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Sales Compliance Specialist
2 days ago
Mabalacat, Philippines Asurion Full timeWe would love for you to explore other opportunities within Asurion. PURPOSE & DESCRIPTION The Sales Compliance Specialist is a subject matter expert that analyzes sales behavior patterns within call center, in-home, and in-store interactions. This role is responsible for inspecting potential compliance risk and reporting findings to internal leadership. The...
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Sales Compliance Specialist
2 days ago
Mabalacat, Philippines Asurion Full timePurpose & Description The Sales Compliance Specialist is a subject matter expert that analyzes sales behavior patterns within call center, in-home, and in-store interactions. This role is responsible for inspecting potential compliance risk and reporting findings to internal leadership. The Specialists review customer interactions and aggregate data to...
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Sales Compliance Specialist
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Mabalacat, Central Luzon, Philippines Asurion Full time ₱900,000 - ₱1,200,000 per yearPurpose & DescriptionThe Sales Compliance Specialist is a subject matter expert that analyzes sales behavior patterns within call center, in-home, and in-store interactions. This role is responsible for inspecting potential compliance risk and reporting findings to internal leadership. The Specialists review customer interactions and aggregate data to...
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Sales Compliance Specialist
2 weeks ago
Mabalacat, Central Luzon, Philippines Asurion Full time ₱900,000 - ₱1,200,000 per yearPURPOSE & DESCRIPTIONThe Sales Compliance Specialist is a subject matter expert that analyzes sales behavior patterns within call center, in-home, and in-store interactions. This role is responsible for inspecting potential compliance risk and reporting findings to internal leadership. The Specialists review customer interactions and aggregate data to...
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Operations Specialist II/Project Specialist I
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Mabalacat, Philippines ENGIE UK Full timeOperations Specialist II / Project Specialist I (For Pooling - Q4) ENGIE UK Mabalacat, Central Luzon, Philippines OPERATIONS SPECIALIST II SUMMARY: This position is responsible to review accounts for accuracy and resolve bill payment edits of various levels of complexity. Using multiple systems, the role resolves pre-identified errors in bills and sends...
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Mabalacat, Philippines Cyzerg Full timeClark Freeport, Philippines Full Time Human Resources About the Company Cyzerg is a technology company specialized in the research, development, implementation, and management of technology solutions for the warehousing industry. With over 148+ active customers across North, Central and South America, Cyzerg has developed industry expertise and capabilities...
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