Utilization Review Specialist
Shodair About the Role
The Utilization Review Specialist supports timely, appropriate patient care by managing utilization review activities across inpatient, outpatient, and residential services. This role coordinates authorizations, reviews clinical documentation, ensures medical necessity, and serves as a key liaison between treatment teams, Medicaid, and private insurance payors.
Ideal Candidate
- Strong clinical understanding of mental health and level-of-care criteria.
- Experienced with Medicaid/private insurance authorizations, pre-auths, and appeals.
- Highly organized, detail-oriented, and able to manage multiple referrals and deadlines.
- Excellent written and verbal communication; professional, clear, and collaborative.
- Calm under pressure, compassionate with youth and families, and maintains a positive demeanor.
- Proficient in Epic, insurance portals, and standard office software.
Why Join Shodair?
You’ll be part of a collaborative, mission-driven team dedicated to improving access to mental health services for children and families across Montana. Shodair offers comprehensive benefits including student loan assistant, 6% 403b employer paid contribution, paid medical and vision insurance, sick leave, and much more. This position starts at $23.65 per hour.
Qualifications
- Bachelor’s degree in social work, psychology, nursing, or related field (or equivalent experience).
- Experience in mental health or crisis intervention preferred.