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.
About the Role
Weβre looking for a detail-oriented and professional Healthcare Quality Assurance & Onboarding Coordinator to support quality assurance, documentation compliance, and onboarding within a healthcare services environment.
The ideal candidate is organised, communicates confidently, and enjoys working with detailed processes that require accuracy and consistency. Youβll play an important role in ensuring that Registered Behavior Technicians (RBTs) submit accurate and complete session notes, follow the required documentation standards, and understand how to use the relevant software and systems.
While the primary focus will be quality assurance and onboarding, the role may also involve occasional HR and administrative support as needed. Weβre looking for someone who is adaptable, takes initiative, and is comfortable stepping in to assist outside their core responsibilities when required.
Requirements
Key Responsibilities
Requirements
Ideal Candidate Profile
The ideal candidate is someone who takes pride in getting the details right. They are comfortable reviewing documentation, following up on outstanding tasks, and ensuring processes are completed correctly rather than simply ticking boxes.
They communicate professionally, can confidently hold team members accountable for completing required documentation, and enjoy helping others learn new systems and processes.
Someone with experience in healthcare administration, clinical documentation, quality assurance, compliance, or training and onboarding would be well suited to this role.
What Success Looks Like
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.