Utilization Review Specialist (Per Diem)

The Florida House•Deerfield Beach, FL

About The Position

FHE Health ("FHE") is a nationally recognized behavioral healthcare institution that delivers quality, medically integrated personalized treatment for those suffering from Behavioral Health Disorders. We specialize in addictive disorders [https://fherehab.com/resources/why-addiction-is-a-disease/] and other behavioral health diagnoses such as mood disorders, depression [https://fherehab.com/mental-health-rehab/depression/], anxiety [https://fherehab.com/mental-health-rehab/anxiety/], and traumatic disorders [https://fherehab.com/mental-health-rehab/trauma/]. We employ a team of highly qualified, compassionate individuals who share in the desire to serve this vulnerable population. We provide innovative treatment by creating an environment that promotes healing and optimized learning. FHE Health is a facility licensed [https://fherehab.com/affiliations-and-accreditations/] by both the Department of Children and Families (DCF) and the Agency for Healthcare Administration (AHCA). We are accredited by both the JOINT Commission and the Commission of Accreditation of Rehabilitation Facilities (CARF) We are members of the National Association of Addiction Treatment Providers (NAATP), and Deerfield Beach’s Best Alcohol and Drug Rehabilitation Center. We are not conventional; we are at the forefront of a medically integrated, modern, scientific, and technological approach to behavioral health and addiction treatment, delivering progressive services not seen in the behavioral health market. As an eight-time "Top Workplace" award winner, we take pride in offering an innovative and collaborative work culture where compassion meets excellence. We are seeking an experienced specialist who is passionate about making a difference in the lives of individuals battling behavioral health and substance use disorder challenges. Responsible for managing all clinical authorization processes to ensure timely, accurate, and compliant communication with insurance payers. This role supports patient access to treatment by securing initial and continued-stay authorizations, preventing avoidable denials, and collaborating with clinical teams to ensure documentation reflects medical necessity according to payer guidelines. The UR Specialist helps maximize reimbursement, maintain compliance, and support quality patient care throughout the behavioral health and addiction treatment continuum.

Requirements

Bachelor’s Degree from accredited college or university in Nursing, Social Work, Behavioral Health or related field required preferred.
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 with clinical teams and insurance reviewers.
Ability to problem-solve, escalate appropriately, and manage time-sensitive deadlines.
High attention to detailed accuracy

Responsibilities

Responsible for managing all clinical authorization processes to ensure timely, accurate, and compliant communication with insurance payers.
This role supports patient access to treatment by securing initial and continued-stay authorizations, preventing avoidable denials, and collaborating with clinical teams to ensure documentation reflects medical necessity according to payer guidelines.
The UR Specialist helps maximize reimbursement, maintain compliance, and support quality patient care throughout the behavioral health and addiction treatment continuum.