Utilization Review Specialist – Behavioral Health (Remote)
Manage behavioral health insurance authorizations for PHP and IOP treatment, coordinating reviews, appeals, and payer requirements to support medical necessity and continuity of care.
Organization: Kyler Cares
POSITION: Diabetes Educator
REPORTS TO: Founders
STATUS: Contractor (1099) - up to 30 hours per month
LOCATION: Remote / virtual work with occasional in person sessions and events
PAY RATE: $55 per hour
WEBSITE: https://kylercares.org/
ABOUT KYLER CARES
At Kyler Cares, we're working to improve health outcomes for people of color living with diabetes by improving access to diabetes technology, creating connections to education and resources, and fostering community as an added system of support on our journeys.
Position Overview
The Educators role: We're looking for someone who talks with kids and teens, not at them, and can make a 30-minute Zoom on low blood sugar feel like time well spent. Brings cultural humility and fluency—you understand that a family's food, language, schedule, and history with the healthcare system all shape how they manage T1D. Treats numbers as stats, not grades, and leads with encouragement instead of shame. Lives in or knows New York City and its neighborhoods well. Truly embodies the Kyler Cares mission and values
Lead the Kyler Care Curriculum
Be the Go-To For Families
Be a Line for School Nurses
Co-Lead With Our Partners
Grow the Clinical Network
Document the Work
Application Process
This position will be accepting applications on a rolling basis until all positions are filled. Due to the high volume of anticipated applicants, we will only reply to applicants that we wish to move forward with during the interview process.
Physical Requirements and Work Environment
The physical demands and work environment described below represent the activities and surroundings of the positions. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. To perform the job, the employee is frequently required to talk and listen on the telephone, and verbally communicate in person with individuals and groups. The position requires frequent keyboarding. The incumbent may occasionally reach with hands and arms and carry materials weighing up to 20 lbs. The incumbent is required to read and respond to documents in electronic form.
Kyler Cares is an EQUAL OPPORTUNITY EMPLOYER committed to providing a non-discriminatory and inclusive environment for its employees. We are committed to diversity and consider all applicants for all positions without regard to color, ethnic background, religion, sex, gender, sexual orientation, national origin, age, or disability status.
Manage behavioral health insurance authorizations for PHP and IOP treatment, coordinating reviews, appeals, and payer requirements to support medical necessity and continuity of care.
Conduct brief clinical intake consultations with adolescents and caregivers, assess safety and treatment needs, guide families toward appropriate PHP or IOP care, and coordinate next steps with clinical teams.
Triage pediatric patients through virtual messages and calls, provide caregivers with clinical assessments and guidance, coordinate with on-call primary care providers, and maintain vaccine and referral records.
Complete, code, review, and audit Minimum Data Set assessments in line with CMS and RAI Manual guidelines, maintaining accurate submissions that support reimbursement and quality reporting.
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