UR Specialist (UTILREV-01)

New Freedom's Career•Phoenix, AZ

1d•Hybrid

About The Position

At New Freedom, we don’t just believe in second chances—we help people thrive because of them. We are a dynamic, compassionate, and peer-driven community dedicated to empowering justice-involved and formerly incarcerated individuals to successfully rebuild their lives and reintegrate into society. Our approach blends empathy with action—offering tools, mentorship, and unwavering support that transforms lives, families, and communities. When you join New Freedom, you join a movement that creates personal, societal, and economic change every single day. If you’re driven by purpose, passionate about people, and ready to make a lasting impact, this is where you belong.

Requirements

Under the supervision of the Chief Clinical Officer, the Utilization Review (UR) Specialist is responsible for managing prospective, concurrent, and retrospective utilization review activities across all behavioral health levels of care.
This position serves as a critical liaison between clinical staff, third-party payers, managed care organizations, and AHCCCS (Arizona Health Care Cost Containment System), ensuring that authorization decisions and clinical documentation meet medical necessity criteria, payer requirements, and all applicable state and federal regulatory standards.
The UR Specialist operates within a multidisciplinary team environment, contributes to quality assurance and compliance initiatives, and plays a key role in supporting the organization’s revenue cycle integrity.
Extensive computer-based work, including use of electronic health records (EHR), utilization management systems, payer portals, and standard office software.
Work is performed in a deadline-driven healthcare environment, requiring adherence to authorization timeframes, regulatory requirements, and payer submission deadlines.
Frequent communication with clinical staff, payers, managed care organizations, and administrative teams is required via phone, email, and electronic systems.
The position may require coordination across multiple programs or levels of care, supporting concurrent review and authorization activities.
Work is generally performed during standard business hours, with occasional flexibility required to meet urgent authorization or review deadlines.
Handling confidential and sensitive patient information and requires strict adherence to HIPAA privacy and security standards.

Responsibilities

Conducting prospective, concurrent, and retrospective utilization reviews for all levels of care, including outpatient, IOP, and PHP.
Reviewing medical records and documentation to ensure accuracy, completeness, and compliance with AHCCCS requirements, payer criteria, and accreditation standards.
Actively contributing to department meetings to review trends, address emerging authorization challenges, and inform process improvement initiatives.
Performing general administrative functions supporting client services, data entry, record management, faxing, and correspondence with payers.
Helping to contribute to an environment of professional accountability.