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.
Work From Anywhere in LATAM or the Philippines
Work Schedule: CST │ 9:00 AM – 5:00 PM (Monday–Friday)
About Pearl Talent
Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund.
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About the Client
An early-stage AI healthtech company is building a clinical co-pilot platform for urgent care practices across the US, and is hiring a Patient Referral Coordinator to take on the human side of its patient referral outreach.
The company's platform flags care gaps in real time and is scaling quickly across its network of urgent care clinics — this is the company's first hire dedicated to this function, with referral outreach currently handled directly by the founding team.
About the Role
As Patient Referral Coordinator, you'll call patients flagged by the platform for specialist follow-up, explain in plain language why the referral matters, address questions or hesitations, and help them book their next appointment — either directly or via follow-up text, email, or voicemail. The role starts light and is expected to scale over the coming months as referral volume grows; success is measured by booking conversion rate and how quickly you respond to new referral notifications.
Core Responsibilities
Patient Outreach & Booking
Follow-Up & Patient Communication
Dashboard & Compliance
Requirements
Requirements
Must-Have
Nice-to-Have
Benefits
If you’re empathetic, organized, and passionate about improving patient experiences through operational excellence, this role is for you. Apply now to help make specialized healthcare more accessible to patients across the U.S.
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.
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.