Behavioral Health Utilization Review Specialist

The Behavioral Health Utilization Review Specialist adjudicates prior authorizations for behavioral health services based on medical necessity and eligibility, adhering to state policy guidelines and best practices. This remote, full-time role involves reviewing submissions, entering outcomes into the Medicaid Management Information System, and providing education and process improvement recommendations to the provider community. The position requires a master's degree in a clinical field, relevant licensure, and experience in utilization management.