[Hiring] Utilization Specialist @Preventive Measures

Role Description

The Utilization Specialist will support Preventive Measures’ Georgia behavioral health operations through authorization management and utilization monitoring while providing quality assurance support for the organization’s Charta AI documentation auditing platform in Washington, DC. The position is designed to improve authorization efficiency, prevent service disruptions, maintain accurate utilization records, and strengthen the accuracy and reliability of AI-driven documentation audits. The contractor will work collaboratively with Operations, Clinical Leadership, Compliance, and Technology teams to identify issues, coordinate resolutions, and support continuous process improvement.

Qualifications

• Experience in authorization management and utilization monitoring.
• Familiarity with clinical documentation auditing platforms.
• Strong communication and collaboration skills.
• Ability to analyze and interpret data related to authorization and utilization.

Requirements

• Monitor and manage initial, continued service, and modification authorization requests.
• Prepare and submit authorization requests through applicable payer portals and systems.
• Review authorization packets to ensure all required documentation is complete prior to submission.
• Coordinate with clinical and operational staff to obtain outstanding documentation.
• Track authorization approvals, denials, pending requests, and expiration dates.
• Ensure approved authorization information is accurately documented in the EHR and authorization tracker.
• Follow up with payers to resolve authorization delays, requests for additional information, and administrative issues.
• Monitor utilization of approved service units and authorization periods.
• Identify consumers approaching authorized unit limits or expiration dates.
• Track remaining authorized units and flag potential service interruptions.
• Identify discrepancies between authorized services, services rendered, and utilization records.
• Communicate authorization and utilization concerns to Georgia Operations leadership.
• Maintain an accurate and up-to-date authorization tracking system.
• Provide regular updates regarding pending authorizations and outstanding requirements.
• Coordinate with clinical leadership regarding documentation needed to support continued service requests.
• Escalate denied authorizations, utilization concerns, and potential service gaps to appropriate leadership.
• Conduct reviews of Charta AI’s clinical documentation audit results.
• Review selected clinical records to validate the accuracy of deficiencies identified by Charta AI.
• Identify false positives and false negatives in documentation issues.
• Evaluate the consistency and reliability of Charta AI’s audit findings across service categories and documentation types.
• Review Charta AI’s ability to identify documentation deficiencies.
• Provide examples and recommendations to support corrections to Charta AI’s auditing functionality.
• Coordinate with leadership teams to communicate identified system issues.

Benefits

• Competitive salary.
• Health, dental, and vision insurance.
• Retirement savings plan.
• Paid time off and holidays.
• Professional development opportunities.

Core Values

• Do the Right Thing - We approach decisions with integrity, honesty, and transparency.
• Own It - We take full responsibility for our role, commitments, and performance.
• Serve First - We show up with a mindset of service to colleagues, clients, and the mission.
• Choose Solutions - We display a solution-oriented mindset and bring constructive energy to challenges.
• Lead with Respect - We treat everyone with respect, communicate professionally, and handle conflict maturely.
• Commit to the Goal - We demonstrate focus, follow-through, and accountability to team objectives.