Job Details

The Utilization Review Specialist is responsible for managing and coordinating the utilization review process for inpatient and outpatient behavioral health services. This role ensures medical necessity, timely authorizations, regulatory compliance, and effective communication with managed care organizations. The Specialist works collaboratively with clinical teams, the assessment department, and leadership to support appropriate level-of-care decisions, optimize reimbursement, and reduce denials. This position requires a minimum of three years of utilization review experience within a behavioral health hospital setting. Qualifications Education: Bachelors degree in Nursing, Social Work, Healthcare Administration, or a related field preferred High School Diploma/ GED required Experience: Minimum of 3 years of utilization review experience in a behavioral health hospital (inpatient and/or outpatient) Demonstrated experience with managed care authorizations, concurrent reviews, and paye...Behavioral Health, Specialist, Healthcare, Patient Services, Authorization, Clinical