Utilization Review Specialist

ADDICTION AND MENTAL HEALTH SERVICES, LLC • Dallas, TX

1d

About The Position

The Utilization Review Coordinator plays a critical role in ensuring that patients at our facility receive the appropriate level of care while managing treatment costs. This position involves coordinating, assessing, and authorizing treatment plans, collaborating with medical staff, and maintaining compliance with healthcare regulations. The Utilization Review Coordinator works closely with insurance companies, clinicians, and support staff to ensure that treatment plans are clinically appropriate and reimbursable, advocating for the best interests of the patients and the hospital.

Requirements

• Bachelor’s degree in Nursing, Social Work, or a related field required. Master’s degree in a health-related field preferred.
• Minimum of 2 years in utilization review, case management, or related field, preferably within a behavioral health or chemical dependency setting.
• Current RN, LCSW, or LPC license preferred.
• In-depth understanding of mental health, substance abuse treatment and ASAM criteria.
• Strong analytical and critical thinking skills with the ability to make clinical judgments based on patient data.
• Excellent communication and interpersonal skills to facilitate interactions with insurers, staff, and patients.
• Proficiency with electronic medical records (EMR) and utilization review software.
• Knowledge of state, federal, and industry regulations related to chemical dependency and mental health care.

Nice To Haves

• Master’s degree in a health-related field preferred.
• Current RN, LCSW, or LPC license preferred.

Responsibilities

• Case Review and Assessment
• Insurance Coordination
• Documentation and Compliance
• Collaboration and Communication
• Quality Improvement

Benefits

• Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.
• Expanded Coverage – Options for domestic partners and a wider network of in-network providers.
• Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.
• Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.
• Student Loan Repayment – Available for nurses and therapists.
• Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.
• Generous PTO – A robust paid time off policy to support work-life balance.
• Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

What This Job Offers

• Job Type: Full-time
• Number of Employees: 1,001-5,000 employees