Utilization Review Specialist

Posted 9 days ago

virtual vocationsNew York (NY)

Substance Abuse and Behavioral Disorder Counselors Outpatient Mental Health and Substance Abuse Centers

SENIORITY

Senior

Apply

About the role

To support the treatment of addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews, collaborating with case managers and the multidisciplinary treatment team to ensure compliance with insurance requirements.

Key responsibilities: Completes pre-authorizations, concurrent reviews, and internal utilization reviews Consults with the treatment team to gather necessary information for concurrent reviews Schedules peer-to-peer reviews and coordinates urgent appeals as needed

Required qualifications: Bachelor's degree in a health or behavioral health-related field required; graduate degree preferred High School diploma or equivalent with a state license (e.g., RN, LPN, LCSW, LMHC) preferred Minimum of three years' experience in a psychiatric or chemical dependency setting Minimum of three years' experience in Utilization Review preferred State licensure preferred (e.g., RN, LPN, LCSW, LMHC)

Before you apply

Applying takes about a minute. These four things decide how fast it moves after that.

Your profile is current

It's what we read first. Occupations, seniority and locations matter more than a long history.

Two examples you can talk through

Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.

A number in mind

What you're on now and what would make you move. We negotiate better when we know both.

Your notice period

Employers plan around it, and it's the question that stalls offers most often.

Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.