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Stella Center · 10 hours ago

Utilization Review Manager – Intensive Outpatient Program(IOP)- California (part/time)

United States

Part-time

Remote

Entry, Mid Level

$30/hr - $50/hr

1+ years exp

Stella Mental Health is a leading provider of breakthrough mental health treatments for depression, PTSD, and anxiety. They are seeking a Utilization Review Manager who will manage all utilization review functions for patients admitted to the Intensive Outpatient Program, ensuring timely patient access to care while maintaining strong payer relationships and regulatory compliance.

Wellness and Fitness Services

Growth Opportunities

Responsibilities

Conduct initial prior authorizations for patients admitting into the IOP level of care, ensuring medical necessity is clearly supported and documented

Manage concurrent utilization reviews throughout a patient’s stay, proactively submitting clinical updates to secure continued authorization

Track authorization periods, approved days, and next review dates to prevent lapses in coverage

Communicate authorization outcomes, denials, and peer-to-peer requirements to clinical leadership in a timely and solution-focused manner

Attend treatment team meetings to stay aligned with clinical progress, treatment goals, and discharge planning

Collaborate closely with therapists, providers, and the Clinical Director to ensure documentation supports ongoing medical necessity

Coordinate care recommendations and treatment milestones with the interdisciplinary team to support authorization requests

Provide guidance to the clinical team on payer requirements, documentation standards, and utilization trends

Ensure all utilization review documentation meets payer, regulatory, and internal compliance standards

Maintain accurate and organized records within the EHR and any utilization tracking systems

Stay current on payer policies, medical necessity criteria, and level-of-care guidelines related to IOP services

Act as the primary point of contact with insurance payors regarding authorizations and clinical reviews

Build and maintain professional relationships with payor representatives to support efficient reviews and positive outcomes

Escalate complex cases, denials, or clinical disagreements appropriately, including coordinating peer-to-peer reviews when needed

Qualification

Utilization ReviewPrior AuthorizationsMedical Necessity StandardsIOP Level-of-Care CriteriaCommunication SkillsCollaboration SkillsAttention to Detail