Stella Mental Health

Compensation

Full Description

About the IOP Stella’s Intensive Outpatient Program (IOP) is a fully virtual program for patients located in California. Our curriculum blends evidence-based psychotherapy, skills training, experiential modalities, and integrated psychiatric care. Some patients enroll solely in IOP, while others participate in IOP alongside interventional or routine psychiatric services offered by Stella’s providers. The program emphasizes flexibility, connection, and whole-person support across the treatment journey. We are seeking a Utilization Review (UR) Manager who will play a critical role in ensuring timely patient access to care while maintaining strong payer relationships and regulatory compliance. This role is responsible for managing all utilization review functions for patients admitted to the Intensive Outpatient Program (IOP), including prior authorizations, concurrent reviews, and coordination with the clinical team to support optimal treatment outcomes. The UR Manager serves as a key liaison between payors and the clinical team, ensuring that medical necessity is clearly articulated and documented throughout a patient’s course of care, with a typical treatment duration target of 45–60 days in IOP. *This is a part-time remote role and must live in California (working 5-10 hours per week to start)* Key Responsibilities Utilization Review & Authorization ● Conduct initial prior authorizations for patients admitting into the IOP level of care, ensuring medical necessity is clearly supported and documented ● Manage concurrent utilization reviews throughout a patient’s stay, proactively submitting clinical updates to secure continued authorization ● Track authorization periods, approved days, and next review dates to prevent lapses in coverage ● Communicate authorization outcomes, denials, and peer-to-peer requirements to clinical leadership in a timely and solution-focused manner Clinical Collaboration & Care Coordination ● Attend treatment team meetings to stay aligned with clinical progress, treatment goals, and discharge planning ● Collaborate closely with therapists, providers, and the Clinical Director to ensure documentation supports ongoing medical necessity ● Coordinate care recommendations and treatment milestones with the interdisciplinary team to support authorization requests ● Provide guidance to the clinical team on payer requirements, documentation standards, and utilization trends Documentation & Compliance ● Ensure all utilization review documentation meets payer, regulatory, and internal compliance standards ● Maintain accurate and organized records within the EHR and any utilization tracking systems ● Stay current on payer policies, medical necessity criteria, and level-of-care guidelines related to IOP services Communication & Relationship Management ● Act as the primary point of contact with insurance payors regarding authorizations and clinical reviews ● Build and maintain professional relationships with payor representatives to support efficient reviews and positive outcomes ● Escalate complex cases, denials, or clinical disagreements appropriately, including coordinating peer-to-peer reviews when needed Qualifications ● Bachelor’s degree required; Master’s degree in a behavioral health or healthcare-related field preferred ● Minimum 1-2 years of utilization review experience, preferably in mental health ● Strong working knowledge of IOP level-of-care criteria (LOCUS criteria) and medical necessity standards ● Experience conducting prior authorizations and concurrent reviews with commercial and managed care payors ● Excellent written and verbal communication skills with strong attention to detail ● Ability to collaborate effectively with multidisciplinary clinical teams What a good job looks like: ● Timely and accurate authorization of care with minimal denials ● Consistent alignment between clinical documentation and payer expectations ● Clear, proactive communication with providers and leadership ● Support of clinically appropriate lengths of stay, typically 45–60 days in IOP, based on medical necessity ● A patient-centered, collaborative approach that balances access to care with compliance and operational excellence What We Offer Opportunity to work with a mission-driven, innovative mental health organization. Collaborative team environment with strong interdisciplinary support. At Stella Mental Health, we believe that diversity, equity, and inclusion are essential values that enrich our work environment and enhance our ability to serve diverse communities. We strive to integrate these values into every aspect of our organization, from hiring and training to policies and practices. We recognize that we have a responsibility to foster a culture of respect, empathy, and collaboration among our team, patients, and partners. Our vision is to be a leader in delivering patient-centered care that respects and celebrates diversity, promotes equity and inclusion, and improves health outcomes for all.