Utilization Review Coordinator

Become an Assembler! If you are looking for a company that is focused on being the best in the industry, love being challenged, and make a direct impact on our business, then look no further! We are adding to our motivated team that pride themselves on being client-focused, biased to action, improving together, and insistent on excellence and integrity.

What You Will Do

• Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plans
• Ensure timely submission of required clinical documentation, including medical necessity letters, progress notes, rating scales, and treatment plans
• Review payer-specific medical policies to determine criteria for Spravato and TMS coverage
• Coordinate with providers, clinical staff, and billing teams to ensure complete and accurate information is submitted
• Frequently tracking and following up on authorization requests, denials, appeals, and renewals
• Maintain detailed records of payer communication, submission timelines, and authorizations received
• Provide support to new customers who are in their start-up phase by navigating authorization processes and clinical documentation.
• Stay current on changes in insurance requirements, payer policies, and clinical documentation standards
• Take on additional projects and tasks as assigned.

What it Takes to Join the Family

• Minimum 2 years of experience in medical prior authorization, utilization review, or billing, preferably in behavioral health or neuromodulation
• Strong working knowledge of medical necessity criteria for Spravato and TMS services, including familiarity with CMS, commercial payer, and MassHealth guidelines
• Experience with a wide range of insurance carriers, including Massachusetts and Rhode Island-specific carriers.
• Comfortable working with EHR systems, payer portals, and medical documentation
• Exceptionally organized, with proven ability to manage multiple priorities and tight deadlines
• Detailed and organized communication skills, both written and verbal
• Ability to work independently and collaboratively with clinical and administrative staff
• Preferred experience with in-network and out-of-network authorization workflows
• Preferred prior work with REMS-certified treatment programs

Why Assembly Health?

• Career growth - your next role with Acme/Assembly Health might not be created yet and we are waiting for your help to chart the way!
• Ongoing training and development programs
• An environment that values transparency
• Virtual and in-person events to connect with your team.
• Competitive Benefit Packages available, Paid Holidays, and Paid Time Off to enjoy your time away from the office.

This is a full-time, non-exempt position reporting to the UR Manager. The compensation range for this position is $21 - $25 per hour.

Compensation for this role is based on a variety of factors, including but not limited to, skills, experience, qualifications, location, and applicable employment laws. The expected salary range for this position reflects these considerations and may vary accordingly. In addition to base pay, eligible employees may have the opportunity to participate in company bonus programs. We also offer a comprehensive benefits package, including medical, dental, vision, 401(k), paid time off, and more.