Utilization Review Manager – Intensive Outpatient Program; IOP- California; part​/time

Stella Mental Health is a leading provider of breakthrough mental health treatments for depression, PTSD, and anxiety. We utilize cutting‑edge modalities, including ketamine infusions, intranasal esket给nanine (Spravato), transcranial magnetic stimulation (TMS), and Stellate Ganglion Block (SGB), to help our patients achieve lasting relief. We are a community of compassionate professionals who support our patients and each other throughout their healing journey.

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).

• 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

• Attend t reatment team meetings to stay aligned with clinical progress, treatment goals, and discharge planning
• Collaborate closely with therapists, providers, and the Erdeine 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

• 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 halls.

• 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

• 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
• სალ excellence excellent written and verbal communication skills with strong attention to detail
Ability to collaborate effectively with multidisciplinary clinical teams

• T…