Utilization Review Specialist

3 days ago

Remote, Oregon, United States Supreme Treatment Center, LLC Full time

About Us

Freedom Recovery and Supreme Treatment Center are leading behavioral health facilities specializing in substance use and co-occurring mental health treatment. We pride ourselves on providing evidence-based care while maintaining financial efficiency through precise authorization and billing practices. We are seeking a Utilization Review Specialist to join our team and take ownership of obtaining authorizations, managing concurrent reviews, and maximizing reimbursable treatment days from insurance carriers.

Position Summary

The Utilization Review Specialist is responsible for managing all insurance-related utilization review functions to ensure clinical services are authorized and reimbursed efficiently. This role requires direct communication with insurance companies, clinical staff, and the billing department to secure pre-authorizations and concurrent days for treatment. The UR Specialist plays a critical role in maintaining census stability, reducing denial rates, and supporting the overall financial health of the program.

Key Responsibilities

  • Obtain pre-authorizations and concurrent reviews for all levels of care (Detox, Residential, PHP, IOP).
  • Review clinical documentation and treatment plans to ensure they meet medical necessity criteria for continued stay.
  • Collaborate with clinical teams to ensure documentation supports ongoing authorization requests.
  • Maintain organized, real-time tracking of authorizations, denial letters, and insurance communications.
  • Communicate daily with billing and admissions to ensure only authorized services are rendered and billed.
  • Track and report average authorized days per client and approval rate per payer to management.
  • Submit appeals and peer-to-peer requests as needed to overturn denials.
  • Stay updated on payer-specific guidelines (Cigna, Aetna, UHC, BCBS, etc.).
  • Proactively identify trends in denied days and collaborate with leadership to improve approval rates.
  • Support the admissions team by verifying coverage and eligibility when needed.

Qualifications

  • Experience: Minimum 2 years of utilization review experience in behavioral health or substance abuse treatment.
  • Education: Bachelor's degree in Nursing, Psychology, Social Work, or related field (preferred).
  • Familiarity with payer systems, electronic health records, and clinical documentation.
  • Strong understanding of ASAM criteria, DSM-5, and payer medical necessity requirements.
  • Excellent written and verbal communication skills.
  • Proven ability to meet deadlines and manage multiple cases simultaneously.
  • Attention to detail and ability to track multiple authorizations accurately.
  • Experience with Zealie, Kipu, or similar EMR/billing systems a plus.

Performance Goals

  • Maintain a minimum 90% success rate in obtaining concurrent days requested.
  • Reduce denied-day ratio and turnaround time for UR submissions.
  • Improve average authorized length of stay per level of care.
  • Provide weekly UR summary reports to management.

Compensation

  • Competitive salary based on experience.
  • Performance bonuses for authorization success and retention metrics.
  • Health, dental, and vision benefits available after 90 days.
  • Growth opportunities within a rapidly expanding treatment network.

Job Types: Full-time, Part-time, Contract

Pay: $ $27.70 per hour

Expected hours: 20 – 40 per week

Benefits:

  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance

Work Location: Remote

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