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: US Timezone (Flexible) | Staggered 9-hour shifts: 6:00 AM – 2:00 PM or 2:00 PM – 10:00 PM ET, transitioning to Sunday–Thursday coverage post-ramp
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.
Hear why we exist, what we believe in, and who we're building for: Watch here: https://www.loom.com/share/863b8e426e6d48309aa8f4ea4c1c94cd
About the Client
A fast-growing digital health company pioneering non-surgical weight loss care is hiring a Patient Navigator to convert inbound patient inquiries into booked clinical consultations and completed treatment decisions.
The company combines telehealth with distributed clinics across 10 US states and a virtual care team of physicians, nurse practitioners, dietitians, and coaches. Founded by leading medical school professors, it is scaling rapidly across multiple US markets and is building a brand-new Client Intake team to support surging patient volume.
About the Role
The Patient Navigator owns two phases of the patient journey. On the front end, they pick up inbound calls, lead pre-scheduled 15-minute video intro calls, screen for financing readiness and benefits eligibility, and book qualified patients for clinical consultations.
Core Responsibilities
Inbound Call Management & Front-End Patient Screening
Post-Consultation Warm Handoff & Closing Support
Documentation, Systems & Metrics Tracking
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.
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.