Job Description
Position:
Utilization Review Specialist Status:
Full Time, Days Schedule:
Mon-Fri, Days. New hire will have the option to choose a schedule of either 7:30am to 4:00pm or 8:00am to 4:30pm. Are you experienced in navigating medical insurance authorizations? We're looking for a Utilization Review Specialist to ensure our inpatient psychiatric patients receive timely access to the care they need — and that our facility is appropriately reimbursed for the services we provide. In this role, you'll conduct admission, concurrent, and continued stay reviews with managed care organizations, commercial insurers, and government payers. You'll work closely with psychiatrists, nurses, therapists, and case managers to make sure clinical documentation supports medical necessity, and you'll manage denials and appeals to protect both patient access and reimbursement. What You'll Do Utilization Review & Authorizations Conduct admission, concurrent, and continued stay reviews for inpatient behavioral health patients Evaluate patient records against payer medical necessity and level-of-care criteria Complete telephonic and electronic reviews with managed care organizations and third-party payers Secure initial and continued stay authorizations; track authorization periods and obtain extensions Submit clinical information on time to prevent authorization lapses and reimbursement delays Denials & Appeals Review denials and coordinate reconsiderations, peer-to-peer reviews, and appeals Prepare appeal packets with supporting clinical documentation Monitor denial trends and identify ways to improve authorization outcomes Clinical Documentation & Team Collaboration Review psychiatric, nursing, and therapy documentation for accuracy and medical necessity support Coach providers and clinical staff on documentation improvements Participate in treatment team discussions to support medical necessity and discharge planning Serve as the go-to resource on behavioral health payer criteria and UR processes Data & Compliance Maintain authorization, denial, and appeal tracking logs with timely, accurate data entry Assist with audits, reporting, and performance improvement initiatives Maintain compliance with federal/state regulations, accreditation standards, and HIPAA What We're Looking For Required:
Associate's degree in healthcare related field — OR a high school diploma/GED with at least 4 years of psychiatric, behavioral health, utilization review, case management, admissions, or related healthcare experience Min 2 years of experience in a psychiatric, behavioral health, or healthcare setting Knowledge of managed care, medical necessity criteria, utilization review, third-party reimbursement, and clinical documentation review Strong organization and time management — you'll juggle multiple payer reviews and deadlines Ready to apply? Submit your resume today Northlake Behavioral Health is an equal opportunity/affirmative action employer. All qualified applicants are encouraged to apply and will receive consideration for all employment; free from discrimination based on race, creed, color, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, religion, associational preferences, status as a qualified individual with a disability, or status as a protected veteran.
