Utilization Review Specialist β 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.
You will be a practitioner on our telehealth platform 'Intellect', where your role is to support our clients' mental health and personal growth based on the individual needs and goals. This is delivered primarily through scheduled 60-minute video sessions on our platform.
This is a freelance remote role with the flexibility to decide your business hours. Local candidates are preferred but others can still be considered. This role is a great opportunity to supplement your current job or private practice.
We're seeking to partner with Clinical Psychologists and Counsellors to be part of a community working collaboratively to bring greater mental health access to the public to provide mental health coaching
What You'll Do
Requirements
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.
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.