[Hiring] Utilization Review Specialist @Mindful Health

Role Description

Utilization Review Specialist: Responsible for ensuring adherence to Mindful Health’s utilization review plan by evaluating the efficiency, effectiveness, and medical necessity of outpatient services, including admissions and extended treatment.

• Must reside in Texas

Duties/Responsibilities

• Establish processes to verify the medical necessity and appropriateness of outpatient admissions
• Conduct concurrent reviews to ensure extended stays are justified and properly documented
• Track patient lengths of stay and continued-stay days
• Refer non-compliant cases to the Physician Advisor for further evaluation
• Collaborate with the Utilization Review Committee to identify and resolve review-related issues
• Flag quality-of-care concerns and escalate them to the Quality Assurance Committee
• Coordinate with Social Services to support timely discharge planning
• Prepare and present monthly utilization reports and key metrics

Qualifications

• Strong verbal and written communication abilities
• Exceptional organizational skills and keen attention to detail
• Proven time management skills with the ability to meet deadlines consistently
• Proficiency in Microsoft Office Suite and related software applications

Requirements

• Associate's or Bachelor’s degree in a healthcare related field preferred
• 1–2 years of experience in utilization review
• Active CPR certification

Physical Requirements

• Ability to sit at a desk and work on a computer for extended periods
• Capable of lifting, holding, pushing, and pulling up to 15 pounds
• Proficient in typing, navigating, and viewing monitors for prolonged durations
• Visual acuity to view monitors with close vision, color perception, depth perception, and focus adjustment
• Effective verbal and written communication skills to engage with patients, team members, and customers
• Ability to read, write, and comprehend information through active listening
• Consistent performance of essential job functions in accordance with ADA, FMLA, and applicable federal, state, and local regulations, including meeting productivity standards
• Reliable and punctual attendance aligned with workplace standards
• Flexibility to work at multiple locations during a scheduled work week
• Mobility to move throughout the office or client sites to assist patients as needed

Benefits

• A healthy & positive atmosphere where everyone is valued.
• Schedule: Monday-Friday, 8AM-5PM CST
• Salary: $25.00 - $30.00 / hr
• 120 hours (15 days) of paid time off annually
• 9 paid holidays
• 40 hours (5 days) of sick leave
• 24 hours (3 days) of bereavement leave per occurrence
• Comprehensive medical and supplemental health insurance, including vision, dental, life insurance, & both short- and long-term disability
• Opportunities for professional development and continued education