Licensed Utilization Review Specialist

Job Summary

To support a growing behavioral healthcare team, the remote Licensed Utilization Review Specialist will ensure clinically appropriate care and cost-effective utilization of services, managing the review process from patient admission through discharge while collaborating with multidisciplinary teams.

Key responsibilities:

• Apply utilization criteria to monitor admissions and continued stay reviews
• Communicate with third-party payers for clinical reviews and document interactions with care team members
• Review patient charts to confirm ongoing medical necessity and prepare appeals for denied cases as needed

Required qualifications:

• Master's Degree in Social Sciences or equivalent experience
• Active substance abuse or mental health licensure in the relevant state
• Minimum of 1 year of experience in a relevant field
• Ability to exercise discretion and maintain confidentiality in client interactions
• Knowledge of medical terminology, ASAM dimensions, and utilization review processes