Utilization Review Specialist at Charlie Health

This role is ideal for a mid-level professional with at least two years of dedicated experience in utilization review, specifically within behavioral health. You should be highly comfortable navigating the complexities of insurance authorizations for Intensive Outpatient Programming (IOP) and possess a solid understanding of medical necessity criteria like InterQual or MCG. While the role is remote, it requires a high level of collaborative energy to work across clinical and revenue cycle teams. The position offers the flexibility of a fully remote work arrangement within a mission-driven, fast-growing mental health organization. You will play a pivotal role in streamlining patient access to care by managing pre-certifications and denial appeals. Please note the significant geographic restrictions; candidates residing in states like CA, NY, WA, CO, and several others are currently ineligible for this role. **You might be a good fit if you...** * Have 2+ years of experience managing insurance authorizations and peer-to-peer reviews. * Are proficient with EMR systems and clinical guidelines (InterQual/MCG). * Enjoy a fast-paced environment where you can troubleshoot workflows and train clinical staff on documentation. * Live in an eligible US state (excluding CA, NY, WA, CO, NJ, CT, MA, OR, MN, AK, ME, or DC).