Utilization Review Specialist – Substance Abuse Treatment Operations
ALL IN SOLUTIONS
full-time
Posted on:
Location Type: Hybrid
Location: Boynton Beach • Florida • 🇺🇸 United States
Visit company websiteSalary
💰 $50,000 - $60,000 per year
Job Level
JuniorMid-Level
Tech Stack
PHP
About the role
- Conduct and submit timely and accurate pre-certifications, concurrent reviews, and continued stay authorizations for clients across all levels of care (Detox, Residential, PHP, IOP).
- Proficiently utilize and document against established medical necessity criteria, including ASAM Criteria, LOCUS, and InterQual, to support clinical justification for treatment.
- Prepare and submit clear, clinically sound documentation for the initial stages of denial appeal and grievance processes.
- Maintain detailed and organized UR documentation within the Electronic Medical Record (EMR), ensuring all records are audit-ready and compliant with internal and external standards.
- Serve as a knowledgeable and professional point of contact for routine communications with payer representatives (insurance companies) regarding authorization requests and follow-up.
- Collaborate with the UR Manager and clinical team to ensure documentation supports full compliance with state licensing regulations (NJ DOH, FL DCF, CA DHCS) and accreditation standards (CARF/Joint Commission).
- Maintain current knowledge of relevant changes to payer guidelines, medical necessity criteria, and state/federal regulations that impact UR processes.
Requirements
- Bachelor’s degree in Healthcare Administration, Social Work, Nursing, Psychology, or a related field strongly preferred (or equivalent professional experience).
- Minimum of 2 years of proven, hands-on utilization review or case management experience in an inpatient behavioral health or SUD setting.
- Direct experience and proficiency in applying ASAM Criteria for patient placement and continued stay justification.
- Demonstrated ability to write clear, compelling clinical justifications for review submissions.
- Proficiency with Kipu EMR systems and general UR tracking/submission tools is highly preferred.
Benefits
- None specified 📊 Resume Score Upload your resume to see if it passes auto-rejection tools used by recruiters Check Resume Score
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization reviewcase managementASAM CriteriaLOCUSInterQualclinical documentationdenial appealgrievance processesmedical necessity criteriabehavioral health
Soft skills
communicationcollaborationorganizationattention to detailprofessionalismwriting skillsclinical justification