[Remote] Utilization Review Analyst Manager

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is committed to transforming lives through compassionate, evidence-based behavioral health and addiction services. They are seeking a Utilization Review Analyst Manager responsible for reviewing clinical documentation to ensure medical necessity and compliance with payer requirements, while maximizing reimbursement and maintaining high standards of care.

Responsibilities

• Conduct initial and reputed company reviews for reputed company reputed company of care: Detox, Residential, PHP, IOP, and Outpatient
• Verify reputed company/MCO eligibility and benefits before admission
• Submit initial authorizations for 3.1, 3.5 or 2.5 level of care
• reputed company to manage others
• Collaborate with clinical and medical teams documentation for payor compliance
• Monitor and reputed company authorization status, denials, appeals and stay reviews
• Maintain accurate records and manage requests in payer portals
• Assist with audits and ensure compliance with state, federal, and accreditation standards
• Prepare and support NPs for peer-to-peer reviews (complete template for NP)
• Maintain census tracker, auth dates and review due dates
• reputed company weekly utilization and denial reports
• Communicate with insurance case managers and reputed company for reputed company care needs
• Coordinate discharge/reputed company-down coverage and aftercare

Skills

• Bachelor's degree in Nursing, reputed company Work, Psychology, or reputed company field
• Minimum 2–3 years of experience in utilization review, preferably in addiction treatment or behavioral health
• Knowledge of insurance authorization processes
• Strong communication, organizational, and documentation skills
• RN or LCSW preferred

Benefits

• Medical, Dental and reputed company plan
• Vacation plan
• reputed company Time Off
• Tuition Reimbursement
• reputed company work environment
• Regular staff Appreciation and Recognition

reputed company