Paradigm Treatment Centers is elevating the mental health of adolescents and young adults ages 12-28 across the United States. Our family of services is comprised of three distinct mental health treatment programs and one therapeutic boarding school. With 13 unique locations, we manage and support 400 employees serving 225 residential clients daily located across five states; California, Idaho, Maine, New Hampshire, and Texas

The Utilization Review Specialist is responsible for directing and overseeing the reporting of utilization statistics and trends, consulting with all services to ensure the provision of an effective treatment plan for all patients, and interfaces with managed care organizations, external reviewers, and other payers.

As an Utilization Review Specialist Here You Will:

• Advises clinical team of documentation necessary to successfully advocate for admission and continued to stay at the most appropriate level of care.
• Utilize clinical information and knowledge of Behavioral & Mental Health Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
• Collaborates with the Admissions and Billing departments, for the purpose of supporting and improving the commercial insurance authorization process.
• Maintain logs and databases for utilization management, fiscal management, care coordination activities, and performance improvement measures.
• Conduct prospective, concurrent and retrospective reviews as required by networks, utilizing telephonic information, medical records, and/or faxed medical information and establish single cases as necessary.

Exciting Things We Offer:

• Medical Benefits
• Mental Health Benefits
• Dental Benefits
• Vision Benefits
• 401(k)
• Remote Position!

Requirements:

• We are excited to have a team member located in the Los Angeles Area.
• Previous Experience with Utilization Review
• Excited to learn about the field of Mental Health