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.
Clinical Pharmacy Specialist
Join our Shields team today! Shields Health Solutions is redefining patient care through health-system integrated specialty pharmacy. We’re hiring an Ambulatory Clinical Pharmacy Specialist who will play a hands-on role in elevating patient care at a nationally recognized Academic Medical Center. In this dynamic, patient‑centered position, you’ll build meaningful relationships with patients and providers while delivering high‑quality medication management. You’ll work remotely, collaborating directly with care teams and practicing under a Collaborative Practice Agreement (CPA) to conduct virtual patient assessments, order and monitor evidence-based treatment plans, optimize therapy, and resolve medication-related problems.
Location: Remote role supporting the Centralia/Olympia/Lacey area
Salary: An employee in this position can expect a salary rate between $127,000 and $142,000 (Hourly Equivalent: Approximately $61.06 - $68.27 per hour, based on a 40-hour workweek.) plus bonus pursuant to the terms of an any bonus plan if applicable. The actual salary will depend on experience, geographic location, and other factors permitted by law.
What You’ll Get:
What You’ll Do:
What You Need:
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Solid computer skills are required, including proficiency in Microsoft Office tools (Outlook, Teams, Word, Excel, and PowerPoint) for communication, documentation, and data management, as well as, navigating the internet and web-based platforms. Data entry and computer skills will be evaluated through an assessment as part of the pre-employment process.
Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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.