Utilization Review Specialist

Charlie Health

Utilization Review Specialist managing insurance authorizations and appeals for Charlie Health’s virtual behavioral healthcare. Improving access and patient outcomes through utilization review and clinical documentation.

Posted 8/20/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $62,000 - $70,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in utilization review processes, medical necessity criteria, and healthcare regulations while effectively managing virtual IOP caseloads. Proficient in delivering training on documentation standards and collaborating across departments to enhance patient experience and operational efficiency.

Highest-signal resume keywords

Utilization Review ProcessesHealthcare RegulationsElectronic Medical Records (EMR)Project ManagementInterQual or MCG Familiarity

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewMedical Necessity CriteriaClinical DocumentationDenial ManagementPeer-to-Peer ReviewPre-CertificationsAuthorizationsBehavioral Health ExperienceTraining DeliveryWorkflow Optimization

Soft Skills

Interpersonal SkillsRelationship-BuildingAnalytical SkillsCommunication SkillsListening Skills

Tools & Technologies

Utilization Management SystemsGoogle ProficiencyElectronic Medical Records (EMR)

Certifications & Qualifications

MD or DOBoard Certified in PsychiatryPsyD or PhDLicensed PsychologistLCSWLMFTLPCLCPC

Industry Keywords

HIPAA CompliancePatient ConfidentialityBehavioral HealthVirtual IOPClinical Guidelines

About the role

Key responsibilities & impact

Oversee all functions of a virtual IOP caseload
Collaborate with the Manager to problem-solve complex cases
Complete pre-certifications and authorizations for virtual IOP clients
Conduct peer-to-peer reviews with insurance medical directors after first-line denials
Follow up on outstanding authorizations and report barriers to the Manager
Collaborate with Revenue Cycle and Admissions to improve the patient experience from intake through discharge
Partner with the Manager and Director to troubleshoot workflows and processes and achieve efficiency gains
Deliver training to clinical teams on high-quality documentation standardization
Participate in denial management, appeals, and peer-to-peer review processes

Requirements

What you’ll need

Current, active, and unencumbered professional license to practice independently in a U.S. state or territory
Physicians: MD or DO, typically Board Certified in Psychiatry or Child/Adolescent Psychiatry
Psychologists: PsyD or PhD and Licensed Psychologist
Master’s-level clinicians: LCSW, LMFT, LPC, or LCPC
2+ years of experience in a utilization role within the behavioral health field
Google proficiency
Strong interpersonal, relationship-building, listening, analytical, communication, and documentation skills
Ability to energize, communicate, and build rapport at all organizational levels
Strong project management skills and ability to manage details in a fast-paced environment
Experience advising, presenting to, and persuading senior corporate personnel
Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations
Familiarity with InterQual, MCG, or similar clinical guidelines
Proficiency with electronic medical records (EMR) and utilization management systems
Understanding of HIPAA and patient confidentiality requirements

Benefits

Comp & perks

Comprehensive benefits for all full-time, exempt employees
Performance bonus
Potential stock options
Other Charlie Health-sponsored benefits