Healthcare Utilization Review Specialist

1 day ago

Tarlac City, Central Luzon, Philippines beBeeUtilization Full time $10,000 - $11,000
Job Description

We are seeking a skilled Healthcare Utilization Review Specialist to support our Residential, PHP, and IOP levels of care. This individual will be responsible for conducting reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.

Responsibilities:
  • Conduct thorough reviews of comprehensive client charts prior to review, including progress notes, psychiatric evaluations, medical vitals, and lab reports.
  • Collaborate with clinical and medical team members to gather updated and relevant information that supports the client's medical necessity for continued care.
  • Maintain a working knowledge of insurance medical necessity criteria (e.g., ASAM, MCG, InterQual).
  • Accurately document all review interactions in the EMR or designated systems.
Required Qualifications
  • Minimum: Licensed Registered Nurse (RN)
  • Preferred: Nurse Practitioner (NP), Medical Doctor (MD/DO), Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD)
  • Minimum of 2 years' experience in behavioral health, substance use, or psychiatric care.
  • Prior experience with utilization review, case management, or insurance authorization processes strongly preferred.
  • Familiarity with insurance platforms and payer-specific guidelines.
  • Excellent communication skills with the ability to represent clinical information clearly and persuasively.
  • Strong attention to detail and ability to work independently and under pressure.
Benefits
  • This is a full-time job
  • 100% Remote
  • Competitive hourly rate
Details
  • Seniority level: Mid-Senior level
  • Employment type: Full-time
  • Job function: Administrative
  • Industry: Hospitals and Health Care

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