Helping families heal.

We believe it. We live it.

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Full-time | M-F 9am - 5 pm | $18-20/hour | Benefits

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The Ascent Programs are licensed, accredited therapeutic programs located in Utah. We have 25+ years of experience using evidence-based practices to help families heal. As our Utilization Review Specialist, you will responsible for maintaining organizational compliance and following all HIPPA regulations while providing compassionate service.

Position Overview

The Utilization Review (UR) Specialist for Behavioral Health is responsible for managing medical necessity reviews, securing authorizations, and preventing denials for inpatient psychiatric and behavioral health services. This fully remote role requires strong clinical judgment, payor communication skills, and a working knowledge of behavioral health level-of-care criteria.

The UR Specialist serves as the bridge between the treatment team and insurance providers, ensuring patients receive medically necessary care while protecting reimbursement and maintaining compliance.

Core Responsibilities

Apply medical necessity criteria using InterQual Behavioral Health, MCG Behavioral Health, or equivalent guidelines
Identify appropriate level of care (acute inpatient, residential, PHP, IOP, etc.)
Collaborate with clinical staff to obtain documentation supporting continued stay
Submit initial authorization requests and complete concurrent reviews with commercial payors
Coordinate peer-to-peer reviews when required
Track authorization periods and proactively prevent gaps in coverage
Escalate concerns regarding adverse determinations or limited day approvals
Assist with drafting appeal letters and supporting documentation for denied days
Monitor trends related to denials and collaborate with leadership to reduce financial risk

Remote Work Expectations

Maintain HIPAA-compliant home office environment
Reliable high-speed internet and ability to manage multiple payor portals
Participate in virtual treatment team meetings and UR huddles
Maintain productivity and quality metrics in a self-directed remote setting

Prior utilization review or case management experience in behavioral health
Strong knowledge of behavioral health medical necessity criteria

Able to pass background criminal investigation checks
Eligible to work in the USA
Proficient in basic computer programs
Proficient in communicating, both verbally and in writing, in English
Reflective listening skills
Empathetic
Clear, honest communication

Preferred

1–3+ years of behavioral health inpatient or residential experience
Experience working with commercial insurance, Medicaid MCOs, and Medicare
Some college in Social Work or Psychology
Professional experience in a treatment facility and/or Inpatient Psych Hospital (RTC, etc.)

Small, close knit team
Health, dental, vision, accident, critical illness, and other insurance plans available after probationary period for full-time employees
Employer contributions to Health Savings Account (HSA)
Free Employee Assistance Program (EAP)

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