Remote: Utilization Review Specialist in Los Angeles, California at Treatment Center Management LLC

Be part of a soul-hearted approach to healing

Alsana is a national leader in eating disorder treatment, offering a holistic, soul-hearted approach to recovery for adults and adolescents of all genders.

We exist to be a source of hope and healing, creating safe, nurturing spaces where individuals can cultivate the roots of their own recovery story.
As a Utilization Review Specialist at Alsana, you will support utilization management activities including medical necessity reviews, clinical documentation, and patient status determination. You will work closely with clinical teams and leadership to help ensure appropriate levels of care, accurate documentation, and compliance with payer and regulatory requirements.

Key Responsibilities
Perform utilization review, including pre-authorization, concurrent, and retrospective reviews for inpatient and/or outpatient services.
Maintain current knowledge of payer requirements, LOCUS criteria, regulatory standards, accreditation expectations, and evidence-based documentation practices.
Use clinical expertise and payer knowledge to act as a liaison to treatment team members through ongoing communication.
Attend weekly Treatment Team Meetings, providing updates on new authorizations and at-risk cases.
Maintain timely, accurate records of review determinations, information requests, and recommendations within the electronic medical record (EMR).
Inspect documentation to confirm compliance with payer requirements, regulatory standards, accreditation expectations, and evidence-based documentation practices.
Assist with appeals, denials management, and corrective actions related to utilization review findings.
Participate in case conferences and provide training and education related to documentation standards and utilization review.
Qualifications
One or more of the following credentials: LPC, LCSW, LMFT, RD, RN, LVN, LPN, or PsyD
Experience in utilization review or case management preferred
Experience in a business/corporate setting or similar environment preferred
Experience in eating disorders preferred
Benefits That Support You

At Alsana, we believe in caring for the people who make our mission possible. Eligible team members enjoy a supportive benefits package designed to support your health, well-being, and growth, including:

• Medical, Dental, and Vision insurance with multiple plan options
(Cigna nationwide; Kaiser available in CA)
HSA plans with employer contributions
FSA Healthcare and Dependent Care plan options
Generous PTO, sick time, Covid Time, and 6 paid holidays
Company-paid Basic Life and AD&D insurance
Short-term disability (company-paid for non-CA; CA uses state plan)
Continuing education stipend for eligible roles
Voluntary benefits including Supplemental Life, Long-Term Disability, Accident, and Hospital Indemnity
LifeMart employee discount program