Utilization Review Coordinator

Utilization Review Coordinator Prosperous Health Los Angeles, CA Job Details Full-time $70,000 - $80,000 a year 1 day ago Benefits Paid holidays Health insurance Paid time off Qualifications Caseload management Pre-authorization review for utilization management Utilization management Resource utilization in healthcare Concurrent review in utilization management

Negotiation Full Job Description Job Title:

Utilization Review (UR)

Coordinator Company:

Prosperous Billing /

Prosperous Health Department:

Revenue Cycle /

Clinical Operations Support Employment Type:

Full-Time (Remote or Hybrid, as applicable) Position Summary The Utilization Review (UR) Specialist at Prosperous Billing is responsible for securing, maintaining, and maximizing insurance authorizations for behavioral health and substance use disorder treatment services. This role serves as a key liaison between clinical teams and insurance payers to ensure medical necessity is clearly documented, authorizations are obtained in a timely manner, and continued stay approvals are optimized to support high-quality patient care and strong revenue cycle performance. Key Responsibilities Authorization & Continued Stay Management Obtain initial and concurrent authorizations for detox, residential, PHP, IOP, and outpatient levels of care Conduct continued stay reviews with insurance payers according to payer-specific timelines Proactively track authorization expirations and submit reviews to prevent lapses in coverage or avoidable denials Clinical Documentation & Medical Necessity Review clinical documentation to ensure alignment with medical necessity criteria (ASAM, MCG, InterQual, and payer-specific guidelines) Collaborate with clinical staff to obtain complete, accurate, and timely documentation Summarize clinical information clearly and professionally for payer utilization reviews Payer Communication & Appeals Communicate directly with insurance reviewers, care managers, and medical directors Participate in peer-to-peer reviews when necessary Support appeals for denied or reduced authorizations through clinical summaries and supporting documentation Revenue Cycle & Compliance Support Maintain accurate authorization records within EMR and billing systems Ensure compliance with payer contracts, regulatory requirements, and internal policies Identify authorization-related risks and trends that may impact reimbursement or revenue integrity Collaboration & Reporting Work closely with billing, admissions, and clinical teams to ensure smooth authorization workflows Provide regular reporting on authorization status, denials, approvals, and trends Support ongoing process improvements to increase authorization success rates and reduce denials Qualifications Required 2+ years of Utilization Review experience in behavioral health and/or substance use treatment Strong working knowledge of ASAM criteria and medical necessity standards Experience obtaining authorizations for residential and outpatient levels of care Excellent verbal and written communication skills Strong organizational skills with high attention to detail Ability to manage multiple cases and deadlines simultaneously Preferred Clinical background (RN, LCSW, LMFT, LPCC, or equivalent licensure) Experience working with commercial insurance payers and Medicaid plans Familiarity with EMR systems and insurance payer portals Prior experience in a billing, revenue cycle, or healthcare operations environment Key Competencies Medical necessity advocacy Payer communication and negotiation Clinical-to-financial alignment Time management and prioritization Critical thinking and problem-solving Professional judgment and confidentiality Compensation & Benefits Competitive salary (commensurate with experience) Health insurance coverage with 50% employer contribution Paid Time Off (PTO) Paid holidays Remote or hybrid work flexibility (role dependent) Performance Metrics (Success Indicators) Authorization approval rate Timeliness of initial and continued stay submissions Reduction in authorization-related denials Accuracy and completeness of documentation Responsiveness and collaboration with internal teams