Utilization Review Specialist

Clearfork Academy • Fort Worth, TX

2d

About The Position

The Utilization Review Specialist at CLEARFORK ACADEMY is responsible for advocating for insurance authorizations and clinical appeals by reviewing and evaluating medical records to support medical necessity. This role ensures appropriate level of care, length of stay, and compliance with existing authorizations or denials while supporting clients throughout their treatment process.

Requirements

• Experience in utilization review, insurance authorizations, or clinical appeals (behavioral health or healthcare setting preferred).
• Strong understanding of medical necessity criteria, levels of care, and payer requirements.
• Ability to analyze clinical documentation and communicate effectively with insurance providers.
• Strong organizational skills with attention to detail and accurate record-keeping.
• Familiarity with applicable healthcare regulations and confidentiality standards.
• Excellent written and verbal communication skills
• Strong analytical and problem-solving abilities
• Ability to work collaboratively with multidisciplinary teams
• Proficiency in electronic health records and documentation systems

Responsibilities

• Advocate for initial authorizations and clinical appeals with insurance providers based on medical necessity, level of care, and length of stay.
• Review and evaluate client medical records, treatment plans, and clinical documentation to support authorization and appeal requests.
• Monitor client charts and records concurrently with treatment to ensure continued authorization and compliance.
• Request, track, and document approvals, denials, and appeal outcomes from insurance companies.
• Collaborate with clinical staff to ensure accurate and timely documentation that supports utilization review needs.
• Collect, compile, and maintain utilization review data in accordance with organizational policies, regulatory requirements, and payer guidelines.
• Ensure compliance with all applicable laws, regulations, and accreditation standards related to utilization review.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 11-50 employees