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Utilization Review Specialist

Title: Utilization Review Specialist

Full-Time · REMOTE · Pay Rate: 24-$30/hour

Purpose: The Utilization Review (UR) Specialist will familiarize oneself with each client chart and obtain/secure maximum number of insured authorization days for each client to complete treatment successfully.

Benefits: Full Benefits (medical, dental, vision, and PTO) – Employer contributes 50%!

Duties and Responsibilities

Duties and Responsibilities will include, but may not be limited to:

  • Liaise between facilities (clients) and various third-party insurance carriers
  • Establish patients’ current insurance information; assist admissions with pre-certification process
  • Manage cases via process of initial analysis, concurrent review, collaboration, and consultation for max. Reimbursement
  • Collaborate with treatment team to decipher best way to obtain maximum number of treatment days for client
  • Communicate with the Verification of Benefits (VOB) team to ensure up to date VOB for every case
  • Stay current on clients’ charts to relay client updates and information to insurance carriers
  • Collect/provide initial & concurrent reviews of patients’ clinical status for insurance companies based on initial and continued stay care criteria
  • Complete insurance/review documentation in a timely manner; facilitate insurance reviews with respective UR depts.
  • Collect and submit data to objectively identify patterns of intervention which result in desired patient outcomes
  • Advocate for patients’ continued treatment per medical necessity; interface with attending physicians, providers, therapists, and admissions for recommendations on patients’ care
  • Assist treatment team with discharge planning, referrals, and patient care/crisis intervention
  • Communicate with peers, medical/clinical team members, and physicians via appropriate org structure/channels
  • Interact with patients’ families and/or significant others and with facilities and accounts in a professional manner
  • Demonstrate clinical competency; observe confidentiality of patient information and HIPAA regulations
  • Adapt to changes positively, work as a team member, and collaborate with other disciplines in provision of care
  • Attend assigned and/or mandatory in-services and staff meetings; read and initial meeting minutes if missed
  • Identify performance improvement opportunities and participate in quality improvement 

Minimum Requirements


  • RN or LVN license preferred
  • Experience working with insurance companies and utilization review
  • Two years’ experience in mental health and/or drug and alcohol treatment facilities preferred
  • Working knowledge of the 12 steps of recovery
  • Familiar with EMR (electronic medical records) systems such as (Kipu, Best Notes, Alleva, Medical Mine, etc.)
  • Proficient with MS Office Suite (spreadsheets, word processing, email, etc.)


  • Enjoys working in a collaborative environment
  • Works with a sense of duty – values strong attention to detail
  • Works with a sense of urgency as these documents are often time-sensitive
  • Ability to multitask, prioritize, and remain organized
  • Excellent interpersonal skills and strong communicationy A desire to help people in a meaningful wa 

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