State Licensed Utilization Review Specialist

Job Summary

To ensure clinically appropriate care and cost-effective utilization of services, the full-time State Licensed Utilization Review Specialist will manage patient admissions, continued stays, and discharges while serving as a liaison between payers and clinical teams in a remote setting.

Key responsibilities

• Apply utilization criteria to monitor admissions and continued stay reviews
• Communicate with third-party payers for clinical reviews and document findings
• Review patient charts to ensure ongoing medical necessity and prepare appeals for denied cases when appropriate

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 independent judgment in job performance
• In-depth knowledge of medical terminology and utilization review processes