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    • Review clinical documentation from internal therapists and medical staff.
    • Night shift (Philippine time equivalent).
    • Up to ₱57,500 per month.
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    • 2-3 years medical charge entry, medical billing or related medical experience.
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    • Meet all attendance, reliability, and night shift scheduling requirements.
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Utilization Review Specialist
Akua Behavioral Health
·
3.6
Remote
PHP 42,500 a month
Full-time
Apply now

Job details

PHP 42,500 a month
Full-time
Remote

Full job description

Job Title: Utilization Review Specialist
Work Setup: 100% Work From Home

Compensation:

Up to ₱57,500 per month

  • ₱42,500 Base Salary
  • ₱15,000 Performance Bonus

Job Overview

We are seeking a detail-oriented and analytical Junior Utilization Review Specialist to join our team. This is a full-time, work-from-home position working directly with our California office and US-based team.

Work Schedule

  • Monday to Friday
  • 8:00 AM to 5:00 PM Pacific Standard Time
  • Night shift (Philippine time equivalent)
  • Must have a high-speed and reliable internet connection

Requirements:

  • Reliable high-speed internet connection
  • Quiet professional home office environment
  • Ability to collaborate with U.S. clinical teams during business hours

Key Responsibilities

  • Review clinical documentation from internal therapists and medical staff
  • Prepare utilization review notes and clinical case summaries supporting medical necessity
  • Assist with initial authorizations, concurrent reviews, and continued stay requests
  • Communicate with internal therapists regarding missing or incomplete documentation
  • Translate clinical documentation into structured UR summaries aligned with payer requirements
  • Advocate for continued treatment authorization when clinically appropriate
  • Track authorization periods and assist with timely submission of insurance reviews
  • Identify documentation gaps that may impact insurance approval or reimbursement
  • Maintain accurate records in the electronic medical record (EMR) system
  • Ensure compliance with HIPAA and company documentation standards

Required Skills and Qualifications

  • Strong analytical skills and exceptional attention to detail
  • Excellent written and verbal English communication skills
  • Strong typing speed and clinical documentation ability
  • Ability to prepare clear, concise, and organized clinical summaries for insurance review
  • Strong communication skills when coordinating with internal therapists and clinical staff
  • Ability to manage workload independently in a remote work environment
  • Proficiency in Microsoft Excel, Word, Outlook, and EMR systems

Required Experience

  • Minimum 2 years experience working with U.S. health insurance (Required)
  • Minimum 2 years experience working in a U.S. behavioral health treatment center (Required)
  • Experience preparing utilization review documentation and clinical case summaries
  • Experience supporting continued stay reviews and insurance authorization processes (Preferred)
  • Experience working with U.S. healthcare organizations or clients (Preferred)

Clinical Knowledge Requirements

Candidates should have experience or familiarity with medical necessity criteria used in behavioral health utilization review, including:

  • ASAM Criteria
  • MCG Care Guidelines
  • InterQual Criteria

Ability to review clinical documentation and align patient presentation with appropriate levels of care required for insurance authorization.

Education and Licensure

  • Active Registered Nurse (RN) License (Required)

Preferred but not required:

  • Active credential in healthcare, behavioral health, social services, or human services

Performance Expectations

  • Ability to complete multiple utilization reviews per day while maintaining documentation accuracy
  • Ability to quickly review clinical charts and prepare medical-necessity focused summaries
  • Maintain strong communication with internal therapists to support continued stay authorization

Job Type: Full-time

Pay: Php42,500.00 per month

Benefits:

  • Work from home

Experience:

  • Work experience in working with US Health Insurance: 2 years (Required)

Language:

  • English (Required)

License/Certification:

  • Registered Nurse (RN) License (Required)

Work Location: Remote

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