Utilization Review Specialist
Recovery Unplugged•Fort Lauderdale, FL
•Remote
About The Position
Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This position plays a critical role in ensuring patients receive the appropriate level of care by obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams throughout the treatment process. The ideal candidate has prior experience in behavioral health utilization review, understands managed care guidelines, and is comfortable advocating for patients with insurance providers.
Requirements
- Previous experience in Utilization Review, Managed Care, Behavioral Health, or a related healthcare setting required.
- Experience working with substance use disorder or behavioral health treatment programs is strongly preferred.
- Strong knowledge of insurance authorization processes and reimbursement practices.
- Excellent verbal and written communication skills.
- Strong organizational skills with the ability to manage multiple cases simultaneously.
- Proficiency with electronic medical records (EMR) systems and Microsoft Office.
- Current clinical licensure is preferred but not required.
- Candidates with significant utilization review experience will be considered.
Nice To Haves
- Candidates residing in Florida, Tennessee, Texas, Virginia, South Carolina, or New Jersey are strongly encouraged to apply.
Responsibilities
- Conduct utilization reviews for admissions and continued stays to establish medical necessity and obtain insurance authorizations.
- Review clinical documentation to support the appropriate level of care and length of stay.
- Present clinical information to insurance companies and managed care representatives to obtain or extend authorizations.
- Communicate with insurance case managers regarding benefits, coverage, and authorization status.
- Collaborate with clinical staff to ensure documentation meets payer requirements.
- Provide guidance to treatment teams regarding insurance criteria, continued stay requirements, and discharge planning.
- Maintain accurate, timely, and organized documentation in accordance with company policies and regulatory standards.
- Work collaboratively with multidisciplinary teams to support quality patient care and reimbursement.
- Protect patient confidentiality and comply with all HIPAA and organizational policies.
- Perform other duties as assigned.
Benefits
- Benefits may be available based on eligibility.
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
No Education Listed
