Utilization Review Specialist
About The Position
Banyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist to join our corporate team. In this remote role, you'll manage a caseload of 50–75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a key liaison between Banyan's clinical operations and the managed care organizations that fund patient treatment. Your work directly protects patient access to care and keeps the business running. This is a high-volume, relationship-driven role for someone who thrives on precision, knows how to navigate managed care, and understands the stakes on both sides of the authorization process.
Requirements
- High school diploma or equivalent
- Minimum one year of utilization review experience in a psychiatric or chemical dependency setting
- Strong organizational, documentation, and communication skills
- Ability to manage high caseloads with accuracy and efficiency
- Comfortable working independently in a remote environment
Nice To Haves
- Graduate degree in a health or behavioral health related field
- Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) — valued but not required
- Experience working with managed care organizations, insurance authorization, and level of care criteria
- Familiarity with Joint Commission standards and behavioral health regulatory requirements
Responsibilities
- Manage a caseload of 50–75 patients, authorizing 15–25 cases daily and ensuring timely utilization reviews and appropriate level of care determinations
- Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards
- Verify insurance benefits, coordinate authorizations, and communicate effectively with external case managers and managed care organizations
- Establish and maintain contracts with managed care companies and request rate increases when appropriate
- Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement
- Identify and address over- and underutilization trends
- Assist in resolving outstanding case issues with insurers
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Whole and term life insurance
- Short- and long-term disability
- 401(k) with employer match
- Paid time off and holidays
- Wellness incentives
- Employee assistance and referral programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
