We are seeking a detail-oriented Utilization Review Specialist to join our team at a behavioral health hospital focused on providing high-quality care and support for individuals facing mental health challenges.

In this role, you will be responsible for reviewing clinical documentation to ensure appropriate care levels, facilitating authorizations, and serving as a liaison between the facility and insurance providers. The ideal candidate will have strong clinical judgment, excellent communication skills, and experience with behavioral health populations.

Key Responsibilities:

• Conduct timely and thorough clinical reviews of patient charts to determine medical necessity.
• Submit and follow up on authorization requests with insurance companies and managed care organizations.
• Collaborate with clinical staff to ensure documentation supports treatment plans and level of care.
• Monitor patient progress to ensure continued authorization and reimbursement.
• Maintain compliance with federal, state, and accreditation requirements.
  
  
  

Qualifications:

• Current RN, LPN, or LCSW/LMSW license preferred.
• Previous experience in utilization review or case management, ideally within behavioral health.
• Strong understanding of medical necessity criteria (e.g., InterQual, MCG).
• Excellent organizational and communication skills.