Utilization Review Specialist

Utilization Review Specialist

Mindful Health is a healthcare provider in Texas that offers a high‑end client experience through both in‑person and virtual services.

Utilization Review Specialist: responsible for ensuring adherence to Mindful Health’s utilization review plan by evaluating the efficiency, effectiveness, and medical necessity of outpatient services, including admissions and extended treatment.
* Must reside in Texas*

• Establish processes to verify the medical necessity and appropriateness of outpatient admissions
• Conduct concurrent reviews to ensure extended stays are justified and properly documented
• Track patient lengths of stay and continued‑stay days
• Refer non‑compliant cases to the Physician Advisor for further evaluation
• Collaborate with the Utilization Review Committee to identify and resolve review‑related issues
• Flag quality‑of‑care concerns and escalates them to the Quality Assurance Committee
• Coordinate with Social Services to support timely discharge planning
• Prepare and present monthly utilization reports and key metrics

• Strong verbal and written communication abilities
• Exceptional organizational skills and keen attention to detail
• Proven time‑management skills with the ability to meet deadlines consistently
• Proficiency in Microsoft Office Suite and related software applications

• Associate's or Bachelor’s degree in a healthcare related field preferred
• 1–2 years of experience in utilization review
• Active CPR certification

• Ability to sit at a desk and work on a computer for extended periods
• Capable of lifting, holding, pushing, and pulling up to 15 pounds
• Proficient in typing, navigating, and viewing monitors for prolonged durations
• Visual acuity to view monitors with close vision, color perception, depth perception, and focus adjustment
• Effective verbal and written communication skills to engage with patients, team members, and customers
• Ability to read, write, and comprehend information through active listening
• Consistent performance of essential job functions in accordance with ADA, FMLA, and applicable federal, state, and local regulations, including meeting productivity standards
• Reliable and punctual attendance aligned with workplace standards
• Flexibility to work at multiple locations during a scheduled work week
• Mobility to move throughout the office or client sites to assist patients as needed

• A healthy & positive atmosphere where everyone is valued
• Schedule:
  
  Monday‑Friday, 8AM‑5PM CST
• 120 hours (15 days) of paid time off annually
• 9 paid holidays
• 40 hours (5 days) of sick leave
• 24 hours (3 days) of bereavement leave per occurrence
• Comprehensive medical and supplemental health insurance, including vision, dental, life insurance, & both short‑ and long‑term disability
• Opportunities for professional development and continued education

The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice. Employee signature below indicates the employee’s understanding of the requirements, essential functions, and duties of the position.