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.
CareMind Health is a captive clinical services entity of Mindoula Health, Inc., and a national provider of virtual psychiatry and comprehensive behavioral health care services. As a patient-centered organization, we are focused on supporting people with their mental health. We create access to convenient, high quality services delivered by compassionate and skilled clinicians. Our goal is to provide our clients with an exceptional experience that improves overall well-being, and restores the foundations of healthy living. We customize and scale these services to provide comprehensive behavioral health solutions for hospitals and other healthcare partners throughout the country. With expertise across the care continuum, we can not only fix pain points that many of our partners encounter - such as provider coverage gaps and ED throughput delays - but also solve complex problems that will improve patient experience, drive outcomes, and lower total cost of care.
We launched Mindoula because each of us had personal experience with mental illness, either directly or through a loved one. We realized that the behavioral health system was broken and decided to take it upon ourselves to fix it by focusing on the people we serve, not their diagnoses or symptom sets. Each of us, and everyone we serve, is a person first and a set of challenges second.
The ideal candidate will have an entrepreneurial spirit, strong clinical operational experience, and thrive in a high-growth environment. They will roll up their sleeves, hire, train and support clinicians, partnering with a cross-functional team, as we grow both our inpatient and outpatient practices.
Essential Duties and Responsibilities:
Education & Work Experience:
Location and Hours:
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.