Utilization Review (UR) Specialist

About the role

We are seeking a dedicated Utilization Review (UR) Specialist to support our mission of delivering quality behavioral health services.

Responsibilities

• Congduct utilization reviews to determine medical necessity and appropriate levels of care for psychiatric and behavioral health patients.
• Collaborate with physicians, nurses, and treatment teams to develop individualized care plans that align with payer requirements.
• Communicate with insurance companies, providing clinical documentation and justifications to support ongoing care.
• Maintain accurate and timely documentation in compliance with state, federal, and organizational standards.
• Serve as a resource for clinical teams regarding payer guidelines, authorizations, and managed care processes.

Requirements

• Experience working in psychiatric, behavioral health, or mental health settings.
• Strong knowledge of managed care, payer guidelines, and utilization management processes.
• Excellent clinical assessment, critical thinking, and communication skills.
• Ability to collaborate across interdisciplinary teams and interact with external stakeholders.
• Nursing license (RN, LPN) preferred, but candidates with strong behavioral health utilization review experience will also be considered.