Utilization Review Specialist (Remote)

The Florida House•Deerfield Beach, FL

8d•Remote

About The Position

FHE Health is seeking an experienced Utilization Review Specialist to manage clinical authorization processes and support timely, accurate, and compliant communication with insurance payers. The role supports patient access to behavioral health and addiction treatment by obtaining initial and continued-stay authorizations, helping prevent avoidable denials, and collaborating with clinical teams to ensure documentation demonstrates medical necessity under payer guidelines. The specialist helps maximize reimbursement, maintain compliance, and support quality patient care throughout the treatment continuum.

Requirements

2–3 years of utilization review experience in behavioral health, addiction treatment, or managed care.
Strong understanding of ASAM criteria, LOCUS, DSM-5, diagnostic standards, and documentation requirements.
Excellent clinical summarization and documentation review skills.
Strong communication skills when working with clinical teams and insurance reviewers.
Ability to problem-solve, escalate appropriately, and manage time-sensitive deadlines.
High attention to detail and accuracy.
The posting states a bachelor's degree from an accredited college or university in Nursing, Social Work, Behavioral Health, or a related field is required preferred.

Responsibilities

Manage clinical authorization processes and communicate with insurance payers in a timely, accurate, and compliant manner.
Secure initial and continued-stay authorizations to support patient access to treatment.
Help prevent avoidable denials.
Collaborate with clinical teams to ensure documentation reflects medical necessity according to payer guidelines.
Support reimbursement, compliance, and quality patient care throughout the behavioral health and addiction treatment continuum.