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.
At Limitlessli, we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs.
The MDS Completion Specialist is responsible for accurately completing and reviewing Minimum Data Set (MDS) assessments in accordance with CMS and RAI Manual guidelines. This role requires strong attention to detail, excellent analytical skills, and the ability to ensure compliance and accuracy in all MDS submissions. The position is fully remote and focuses primarily on accurate coding and completion of MDS assessments.
This position is remote and offers you the flexibility of working from home.
Industry standards applicable to the state depending on work experience and level of expertise.
US Eastern Standard Time – Monday to Friday, 9am to 6pm
We embrace the flexibility and convenience of a remote working environment, and you will collaborate with an international team while contributing to our growing business, all from the comfort of your home.
You will need to have some essential tools – a reliable computer and noise-cancelling headset, a second monitor for enhanced productivity, and a stable internet connection. You’ll also be required to have a backup internet connection, ensuring that you’re well-equipped to complete your work seamlessly.
Don't miss out on this opportunity – apply now and become a valuable member of the Limitlessli team! If you're interested in what you have read, then we invite you to take the next step and submit your application.
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.
Schedule and coordinate telehealth appointments, guide patients through virtual visit preparation, maintain accurate records, and support a smooth, compassionate experience between patients and healthcare providers.
Processes and reviews clinical safety cases and reports, supports pharmacovigilance compliance and signal monitoring, and coordinates with study teams and cross-functional partners to ensure accurate, timely safety reporting.