Utilization Management Specialist II

📋 Description

• Review and validate service authorization requests against benefit requirements and submission
• Check requests for completeness, accuracy, and required supporting documentation before they
• Identify missing, inconsistent, or incomplete information and coordinate with providers to obtain
• Route complete requests to the appropriate clinical reviewer based on service type, urgency, and
• Monitor authorization timelines and follow up proactively to help prevent delays in clinical review
• Track authorization determinations and maintain accurate status information within relevant systems.

🎯 Requirements

• High school diploma/GED plus 6 years of experience working in the mental health, substance use, or
• Associate degree plus 4 years of relevant experience
• Bachelor's degree plus 2 years of relevant experience
• Equivalent combination of education and relevant professional experience
• Experience working with behavioral health, mental health, substance use, physical health, or
• Familiarity with medical terminology and healthcare-related documentation is preferred

🎁 Benefits

• Salary range of $56,270–$69,898 annually
• Remote work options for most positions, with this role specifically based remotely within North
• Typical working hours of 8:30 a.m.–5:00 p.m. with flexible schedules available for some roles
• Health insurance with no employee premium for employee coverage
• Flexible Spending Accounts (FSAs)
• 24 days of paid time off (PTO) plus 12 paid holidays during the first year