Helping families heal. We believe it. We live it. ______________________________________________ Full-time | M-F 9am - 5 pm | $18-20/hour | Benefits ______________________________________________ The Ascent Programs are licensed, accredited therapeutic programs located in Utah. We have 25+ years of experience using evidence-based practices to help families heal. As our Utilization Review Specialist, you will responsible for maintaining organizational compliance and following all HIPPA regulations while providing compassionate service. Position Overview The Utilization Review (UR) Specialist for Behavioral Health is responsible for managing medical necessity reviews, securing authorizations, and preventing denials for inpatient psychiatric and behavioral health services. This fully remote role requires strong clinical judgment, payor communication skills, and a working knowledge of behavioral health level-of-care criteria. The UR Specialist serves as the bridge between the treatment team and insurance providers, ensuring patients receive medically necessary care while protecting reimbursement and maintaining compliance. Core Responsibilities - Apply medical necessity criteria using InterQual Behavioral Health, MCG Behavioral Health, or equivalent guidelines - Identify appropriate level of care (acute inpatient, residential, PHP, IOP, etc.) - Collaborate with clinical staff to obtain documentation supporting continued stay - Submit initial authorization requests and complete concurrent reviews with commercial payors - Coordinate peer-to-peer reviews when required - Track authorization periods and proactively prevent gaps in coverage - Escalate concerns regarding adverse determinations or limited day approvals - Assist with drafting appeal letters and supporting documentation for denied days - Monitor trends related to denials and collaborate with leadership to reduce financial risk Remote Work Expectations - Maintain HIPAA-compliant home office environment - Reliable high-speed internet and ability to manage multiple payor portals - Participate in virtual treatment team meetings and UR huddles - Maintain productivity and quality metrics in a self-directed remote setting

• Own the lifecycle of clinical pathways and practice guidelines from drafting through rollout and iteration • Create concise, AI-native, usable protocols that drive consistent, high-quality virtual care • Define escalation criteria, exclusion criteria, referral pathways, and safety thresholds for virtual-first care • Ensure guidelines are communicated and implemented through training, documentation standards, and workflow integration • Ensure guidelines are deployed through an AI-friendly interface • Continuously refine how care is delivered across intake, triage, assessment, treatment planning, follow-up, and escalation • Identify operational bottlenecks and redesign workflows to improve quality, speed, and patient experience • Standardize high-performing clinical practices and reduce unwarranted variation • Assist with QA and performance review of Doctronic Physician Group providers • Assist the product team with clinical design for new programs and condition pathways • Define eligibility, care cadence, clinical requirements, safety guardrails, and success metrics • Partner with Product and Engineering to translate clinical logic into usable product and workflow experiences • Drive clinical readiness for launches and ensure safe, coherent execution at go-live • Lead practice quality and patient safety initiatives across the care model • Maintain a functioning safety event pipeline and review process with timely corrective actions • Run continuous learning loops through structured case review and quality audits • Define quality metrics, monitoring dashboards, and improvement targets with Analytics • Maintain a practice within the Doctronic AI-Native Care platform

• Rely on medical background and review health claims • Work assignments involve moderately complex to complex issues where analysis requires in-depth evaluation of variable factors • Make determinations whether to authorize requested services, request level of care, and requested site of service • Conduct Utilization Management of the care received by members in an assigned market, member population, or condition type • Participate in care management and discussions with external physicians • Review clinical records, prioritize daily work, and communicate decisions • Support regional market priorities, which may include understanding Humana processes

• Lead and execute the clinical development strategy for gene therapy programs • Provide medical and scientific input into clinical trial design and protocol development • Oversee all clinical trials from initiation through completion • Collaborate with internal cross-functional teams and external partners • Conduct clinical risk assessments and implement appropriate mitigation strategies • Contribute to regulatory interactions • Present clinical data and development updates to senior management • Supervise and mentor clinical team members • Establish and maintain oversight of clinical monitoring activities • Author and review key clinical and regulatory documents