Utilization Review Coordinator

Job Summary

The Utilization Review Coordinator is responsible for securing and maintaining payer authorizations for behavioral health services, ensuring medical necessity, appropriate level of care placement, and reimbursement optimization. This role serves as the liaison between clinical teams, admissions, and insurance payers to support continuity of care and financial sustainability.

Qualifications

• Bachelor’s degree required, master’s preferred
• 2–5+ years in behavioral health, substance use treatment, or utilization review
• Experience with insurance authorization processes and medical/clinical necessity criteria
• Familiarity with ASAM criteria strongly preferred
• Strong clinical documentation review skills
• Knowledge of payer systems (State Contracts, FFS Initiatives, Medicaid, MCO, Third Party)
• Excellent communication and negotiation skills
• Detail-oriented with strong organizational abilities
• Able to manage multiple cases and deadlines

Benefits

• For full time positions, (30+ per week) we offer:
• We provide PAID training
• Medical/vision and dental
• Life insurance (agency-paid), supplemental life insurance (employee-paid)
• Flexible spending accounts
• Accidental/Critical Illness Insurance
• 403B (with company-matching)
• Generous paid time off