Utilization Review Specialist

Utilization Review (UR) Specialist Location: Open to candidates near Wyomissing PA & Chadds Ford PA (Hybrid / Remote Eligible) Job Type: Full-Time Schedule: Monday – Friday Overview Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented and experienced Utilization Review (UR) Specialist to support our behavioral health programs. This role plays a critical part in ensuring services are medically necessary, appropriately authorized, and compliant with payer, state, and regulatory requirements while supporting timely reimbursement and quality care delivery. Why Join DTAC Flexible hybrid or remote work optionsCollaborative, cross-functional team environmentMeaningful work supporting behavioral health servicesStable organization focused on quality and growthOpportunities for professional development Position Summary The Utilization Review Specialist manages the full lifecycle of authorizations and eligibility verification. This role collaborates closely with Clinical, Admissions, and Revenue Cycle teams to ensure compliance, minimize denials, and support accurate billing and reimbursement. Key Responsibilities Conduct initial, concurrent, and continued stay utilization reviewsSubmit, track, and manage authorizations and reauthorizationsCommunicate authorization updates with clinical and admissions teamsMaintain accurate documentation in EHR and billing systemsPerform ongoing eligibility verification for active clientsIdentify coverage changes and communicate impacts to appropriate teamsReview clinical documentation for medical necessity and complianceCollaborate with clinicians to address documentation gapsSupport denial prevention and revenue cycle optimizationAssist with appeals and utilization-related inquiriesParticipate in audits, quality improvement initiatives, and compliance reviewsStay current with payer requirements and regulatory updates Qualifications Required: Bachelor’s degree in Healthcare Administration, Nursing, Social Work, Psychology, or related fieldMinimum of 1–3 years of experience in utilization review, case management, or behavioral health revenue cycleStrong understanding of medical necessity and authorization processesExcellent attention to detail and analytical skillsStrong written and verbal communication skills Preferred Experience with Pennsylvania and Ohio behavioral health payersFamiliarity with EHR systems and billing workflowsExperience supporting audits, compliance reviews, or appeals Requirements Ability to manage multiple priorities and deadlinesStrong collaboration across clinical, billing, and administrative teamsCommitment to compliance with regulatory and payer requirementsAbility to work hybrid or remotely depending on organizational needs Benefits 401(k)Health, Dental, and Vision InsuranceHealth Savings AccountPaid Time OffLife and Disability InsuranceEmployee Assistance ProgramReferral Program Work Location Open to candidates near Chadds Ford, PA (19317) and Wyomissing PA (19610) with hybrid or remote work options available based on business needs. Apply Today If you are a detail-driven professional with experience in utilization review or behavioral health operations, we encourage you to apply and join DTAC’s team. Equal Opportunity Employer Diversified Treatment Alternative Centers is committed to providing equal employment opportunities and maintaining an inclusive workplace in accordance with all applicable laws.