,About the Lotus Collaborative:
The Lotus Collaborative (TLC) provides holistic eating disorder recovery services, specializing in the treatment of anorexia, bulimia, binge eating disorder, orthorexia and disordered eating in Santa Cruz and San Francisco, CA. TLC offers a partial hospitalization program (PHP), an intensive outpatient program (IOP), and outpatient nutrition and counseling services.
Qualifications:
The Lotus Collaborative is looking for a part-time Utilization Review Specialist to join the team. The ideal candidate has:
- Bachelor’s degree (a degree in psychology, social work, public health or related field is preferred)
- Experience in admissions, case coordination or healthcare administration (preferably in behavioral health or eating disorder settings)
- Familiarity with utilization review processes and insurance documentation
- Working knowledge of BestNotes or similar EHR systems
- Strong organizational skills and attention to detail
- Excellent communication and interpersonal skills, with the ability to support families during times of stress
- Comfortable with multi-tasking and managing competing priorities
This position is approximately 10-20 hours per week, including availability during weekday business hours.
Job description:
The Utilization Review Specialist is a central member of the admissions and clinical operations team at The Lotus Collaborative. This position supports the seamless transition of clients in our eating disorder and mood and trauma treatment programs, maintains oversight of client documentation and communication workflows, and ensures ongoing compliance with insurance and quality care standards. The specialist functions as both the administrative liaison and utilization review coordinator across both Santa Cruz and San Francisco locations, ensuring continuity and excellence in client care from inquiry through discharge.
Tasks include:
- Obtain insurance authorizations for all admissions, including clients covered by Kaiser, county programs, and private insurance
- Secure single case agreements for clients with out of network coverage
- Maintain ongoing communication with insurance case managers and care coordinators
- Ensure timely and accurate submission of pre-authorization and continued stay reviews and documentation
- Schedule and support peer-to-peer reviews as needed
- Monitor upcoming insurance reviews and authorizations; flag and resolve issues proactively
- Provide necessary documentation for retrospective reviews when required and follow up on timely completion
- Perform ongoing chart audits for UR compliance
- Transfer attendance information to Avea for billing and reconcile billing records for accuracy
- Attend and document all treatment team meetings to collect and document utilization data
- Initiate Outcome Tools Series and send anonymous feedback surveys to clients, families, and providers
- Provide necessary support to the Operations and Admissions teams as requested, including client communication tasks
Other relevant information:
Lotus provides a supportive, collaborative team and work environment. This is an excellent opportunity to gain experience in the field of behavioral health care.
The Lotus Collaborative serves a diverse population because eating disorders are prevalent among many populations/races, classes, gender identities, and sexual orientations. To that end, we are committed to inclusion in our staff, and offer special consideration to BIPOC, LGBTQI+ and other persons representing marginalized communities.
Thank you for your interest!
Job Type: Part-time
Pay: $28.00 - $32.00 per hour
Education:
Location:
Work Location: Remote
