Utilization Review Lpc Jobs in Oregon (NOW HIRING)

Overview

Salary: $120,000 - $130,000 as year (DOE)

Location: RemoteReporting to: Chief Financial Officer

The Director of Payer Compliance  is a senior leadership role responsible for ensuring that clinical programming and documentation is in compliance with payor requirements and applicable governmental regulations across all levels of care, including PHP, IOP, OP, Residential, and Adolescent Services.

This role provides strategic oversight and handson leadership in the development, implementation, and continuous monitoring of clincial programming from admit to discharge.

The ideal candidate has extensive experience working at a behavioral health company in managed care environment. Payer experience is not required but an understanding of billing and revenue cycle management is essential.

Responsibilities

• Lead the development of enterprise-wide strategies to align operations and clinical programming to align with payer requirements across all levels of care (PHP, IOP, OP, Residential; Adult & Adolescent)
• Interpret and operationalize payer-specific policies, medical necessity criteria, and reimbursement requirements across multiple insurance providers
• Design, implement, and continuously refine systems and processes that ensure organizational readiness for payer review and reimbursement
• Conduct targeted audits of clinical documentation, utilization review practices, and workflows to ensure alignment with payer expectations
• Identify gaps in current processes and implement solutions that improve documentation quality, payer alignment, and revenue capture
• Track and analyze key performance indicators, including denial trends, documentation accuracy, and payer-specific outcomes
• Develop dashboards and reporting tools to provide visibility into payer performance and organizational effectiveness
• Partner cross-functionally with finance, billing, clinical leadership and operations to drive continuous improvement and reduce reimbursement risk
• Lead initiatives to enhance documentation standards and support medical necessity justification
• Provide expertise during payer audits, reviews, and appeals processes to support optimal reimbursement outcomes
• Design and deliver training, tools, and guidance to ensure teams understand and meet payer expectations.

Qualifications

• Master's degree in Behavioral Health, Healthcare Administration, Nursing, or related field preferred
• Independent clinical licensure (e.g., LMHC, LCSW, LPC, RN) strongly preferred
• 5-7+ years of progressive experience in:
  • Behavioral health operations, utilization review, or revenue cycle
  • Working directly with insurance payers and reimbursement requirements
  • Payer strategy, revenue integrity, or documentation quality initiatives

• Deep expertise in payer-specific medical necessity criteria and insurance requirements across multiple payers
• Strong experience building systems, workflows, and audit processes that improve reimbursement outcomes
• Proven ability to analyze data, identify trends, and implement process improvements tied to financial and operational performance
• Strong cross-functional leadership skills with the ability to influence clinical, operational, and financial stakeholders.

Benefits

• Access to professional growth using our cutting-edge strategies and trainings with our exceptional leaders.
• Medical, Dental & Vision Insurance - Multiple plan options including PPO and HDHPs with HSA eligibility and company contributions.
• Paid Parental Leave - Up to 6 weeks fully paid for exempt employees and 4 weeks for non-exempt.
• Life & Disability Coverage - Company-paid life, AD&D, and long-term disability; voluntary life and optional short-term disability available.
• 401(k) with Company Match - Retirement savings with matching contributions after eligibility period.
• PTO & Holidays - Competitive PTO accrual plans and paid holidays throughout the year.
• Employee Assistance Program (EAP) - Free, confidential support for life's challenges.

Embark is an Equal Employment Opportunity Employer. We are committed to enriching the therapeutic and healing experience we offer through the diversity of our employees and community. We actively seek to recruit and support a broadly diverse staff who contribute to our excellence, diversity of viewpoints and experiences, and relevance in a global society.

Embark does not discriminate on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, marital status, veteran status, or any other protected status under applicable laws. Accommodations are available for applicants with disabilities.

Employment Type: FULL_TIME