Behavioral Health Utilization Management Specialist
About the role
At Row Partners, we’re more than a healthcare support organization — we’re a passionate team dedicated to empowering behavioral health facilities and their patients. We believe that compassionate, accessible, and high-quality care starts with the right people on our team. Our Behavioral Health division is growing, and we’re looking for a Behavioral Health Utilization Management Specialist who shares our commitment to improving access, ensuring appropriate care, and supporting patient success stories every day. If you’re driven by purpose, thrive in a collaborative environment, and want your work to make a real difference, this role is for you.
The Role: As a Behavioral Health Utilization Management Specialist, you will be the bridge between clinical care and insurance coverage — ensuring patients receive the right services, at the right time, for the right reasons. Your expertise will help providers, patients, and payers work together toward the shared goal of better behavioral health outcomes.
Responsibilities
- Champion patient care by reviewing medical records and clinical documentation to determine medical necessity and appropriateness of behavioral health services.
- Collaborate and connect with clinicians, medical staff, and insurance providers to make sure patients get timely access to the services they need.
- Conduct clinical reviews for inpatient, outpatient, and residential behavioral health services.
- Ensure quality of care by reviewing treatment plans, discharge plans, and progress toward goals.
- Support evidence-based treatment by applying clinical criteria and guidelines to approve and recommend necessary care.
- Stay ahead of industry standards, insurance requirements, and treatment protocols.
- Advocate for patients by facilitating communication and resolving barriers between providers, patients, and payers.
- Document with precision for utilization reviews, audits, and compliance needs.
Requirements
- 2+ years in utilization management, case management, or behavioral health services