Description

You will oversee a virtual IOP caseload, complete pre-certs and authorizations, and collaborate with clinical teams to streamline the utilization process, ensuring patients receive timely care.

Requirements

• High School Diploma
• 2+ years of experience in a utilization role within the utilization review field
• Google proficiency
• Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations
• Familiarity with InterQual, MCG, or similar clinical guidelines

Responsibilities

• Oversee all functions of a virtual IOP caseload
• Complete pre-certs and authorizations for virtual IOP clients in a timely manner
• Follow up on outstanding authorizations and report barriers to Manager
• Collaborate with Revenue Cycle Team and Admissions to improve patient experience
• Participate in denial management, appeals, and peer-to-peer review processes