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.
Movn Health is the leading virtual cardiac rehab program: our proven program helps patients recover at home, on their schedule, with outcomes that match in-person rehab and $10,000+ in savings per patient. Our goal is to grow access to rehab within our provider and payer partners to improve and extend the lives of our patients. That's where you come in. You'll be our person on the ground across upstate New York and Western Massachusetts - visiting cardiology practices, hospitals, and provider offices to build awareness, drive referrals, and troubleshoot stalled referrals.
This role is requires 75% local travel to hospitals and clinics in Upstate New York. Candidates should only apply if they are within driving distance or Buffalo, Rochester & Albany, NY.
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.