Utilization Review Specialist

Overview
We are seeking a dedicated and detail-oriented Utilization Review Specialist to join our team at Yonder Behavioral Health. The Utilization Review Specialist plays a critical role in ensuring appropriate and medically necessary care for patients at Yonder Behavioral Health. This position is responsible for managing utilization review and authorizations for ASAM level 3.5 treatment, working closely with clinical teams to document medical necessity and to facilitate coverage with insurance providers. The ideal candidate will have a strong understanding of ASAM criteria and experience with utilization review processes in a behavioral health setting.

Duties

• Authorization & Review Management: Coordinate with insurance providers to secure authorizations for patient admissions, continued stay, and discharge planning, ensuring alignment with ASAM level 3.5 criteria.
• Documentation: Maintain accurate, detailed, and timely documentation to support medical necessity, treatment progress, and compliance with insurance requirements.
• Case Review: Conduct ongoing clinical case reviews with the treatment team to assess patient progress and determine ongoing needs for care, facilitating appropriate authorizations.
• Collaboration with Clinical Staff: Work closely with therapists, case managers, and the clinical team to gather necessary documentation and communicate insurance requirements.
• Insurance Liaison: Act as the primary point of contact for insurance representatives, advocating for patients’ treatment needs and maximizing coverage through clear, effective communication.
• Compliance: Ensure all utilization review processes adhere to ASAM, HIPAA, and other regulatory guidelines.
• Reporting & Analysis: Track and report utilization review data, including authorization rates, denials, and appeals; provide insights to improve workflows and increase authorization success rates.

Experience

• 3 years of experience in utilization review, insurance authorization, or a related field within behavioral health or substance abuse treatment, with specific experience in ASAM level 3.5 care preferred.
• Excellent communication skills, both verbal and written, with the ability to work collaboratively in a team-oriented environment.

If you are passionate about enhancing patient care through effective utilization management and meet the qualifications outlined above, we encourage you to apply for this rewarding opportunity.

Job Type: Full-time

Pay: $19.00 - $20.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Ability to Commute:

• Berea, KY 40403 (Required)

Ability to Relocate:

• Berea, KY 40403: Relocate before starting work (Required)

Work Location: In person

Salary : $19 - $20