Utilization Review Specialist

KVC Health Systems • St. Louis, MO

4d

About The Position

Camber Connect is seeking a detail-oriented, compassionate Utilization Review Specialist to join its Utilization Review department. The specialist serves as a link between clinical treatment teams and health plans, managing initial, concurrent, and discharge interfaces so children, youth, and adolescents receive needed services. The role calls for accuracy, urgency, and patient advocacy in a fast-paced clinical environment.

The position involves communication with health plans, coordination with clinical and admissions teams, EHR data integrity, and support for quality assurance and regulatory compliance. Camber describes its workplace as supportive and values authenticity, compassion, diverse perspectives, innovation, employee wellbeing, and a solutions-focused approach.

Requirements

• High school diploma or GED.
• Valid driver’s license and auto insurance.
• Proficiency with EHR systems.
• Strong understanding of medical terminology and healthcare regulations.
• Excellent critical-thinking skills and ability to work in a fast-moving, high-detail environment.
• Collaborative approach and ability to communicate professionally with diverse healthcare teams and insurance providers.

Nice To Haves

• Bachelor’s degree in a Human Services field, such as Social Work, Psychology, Sociology, Education, or Applied Behavioral Sciences, or in Criminal Justice.
• Experience in a hospital or clinical setting, particularly with at-risk youth and families.

Responsibilities

• Serve as the primary point of contact for health plans, provide clinical updates, and manage authorizations.
• Collaborate with physicians, nurses, and therapists to ensure timely and complete patient assessments.
• Coordinate with Admissions to facilitate appropriate referrals and placements.
• Maintain data integrity in Electronic Health Record (EHR) systems.
• Navigate insurance policies and reimbursement procedures to support patient care.
• Assist with quality assurance audits and compliance with state, federal, and Joint Commission guidelines.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED