Utilization Review Specialist

Utilization Review (UR) Specialist Location: Chadds Ford, Pennsylvania (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 options Collaborative, cross-functional team environment Meaningful work supporting behavioral health services Stable organization focused on quality and growth Opportunities 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 reviews Submit, track, and manage authorizations and reauthorizations Communicate authorization updates with clinical and admissions teams Maintain accurate documentation in EHR and billing systems Perform ongoing eligibility verification for active clients Identify coverage changes and communicate impacts to appropriate teams Review clinical documentation for medical necessity and compliance Collaborate with clinicians to address documentation gaps Support denial prevention and revenue cycle optimization Assist with appeals and utilization-related inquiries Participate in audits, quality improvement initiatives, and compliance reviews Stay current with payer requirements and regulatory updates Qualifications Required: Bachelor’s degree in Healthcare Administration, Nursing, Social Work, Psychology, or related field Minimum of 1–3 years of experience in utilization review, case management, or behavioral health revenue cycle Strong understanding of medical necessity and authorization processes Excellent attention to detail and analytical skills Strong written and verbal communication skills Preferred Experience with Pennsylvania and Ohio behavioral health payers Familiarity with EHR systems and billing workflows Experience supporting audits, compliance reviews, or appeals Requirements Ability to manage multiple priorities and deadlines Strong collaboration across clinical, billing, and administrative teams Commitment to compliance with regulatory and payer requirements Ability to work hybrid or remotely depending on organizational needs Benefits 401(k) Health, Dental, and Vision Insurance Health Savings Account Paid Time Off Life and Disability Insurance Employee Assistance Program Referral Program Work Location This position is based in Chadds Ford, PA (19317) 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. #J-18808-Ljbffr Diversified Treatment Alternative Centers (DTAC)