Utilization Review Specialist
HealthOp SolutionsUnited States11 hours agoUSD 70k - 90k
Full TimeMid-level
Job Overview
Date Posted
Posted on 23rd October 2025
Expiration Date
Expires on 22nd December 2025
Salary
USD 70k - 90k
Job Categories
Healthcare Utilization-Management-SpecialistUtilization Management-SpecialistUtilization Review-NurseUtilization Management-Nurse
The Utilization Review Specialist is seeking a detail-oriented and experienced professional to manage authorizations, Single Case Agreements, and continued stay reviews for residential, PHP, IOP, and outpatient clients.
The Utilization Review Specialist is seeking a detail-oriented and experienced professional to manage authorizations, Single Case Agreements, and continued stay reviews for residential, PHP, IOP, and outpatient clients. This role involves securing timely approvals from commercial payers and collaborating with clinicians and insurance teams to ensure treatment adherence. The position is remote and offers flexible work.
Requirements
- 3–5 years of experience in utilization review, medical billing, or a related field (behavioral health preferred)
- Strong background working with commercial payers and medical necessity criteria
- Proven success managing Single Case Agreements (SCAs) and continued stay authorizations
- Bachelor’s degree in Healthcare Administration, Social Work, Nursing, or related field preferred
Benefits
- Medical, Dental, and Vision Insurance
- Paid Time Off
- 401(k)
- Tuition Reimbursement
- Gym and Yoga Membership Reimbursement
- Life Insurance & HSA Options
- Professional Development Assistance