Utilization Review Specialist

Help Adolescents Build a New Legacy

At Clearfork Academy, we provide high-quality substance abuse and mental health treatment for adolescents and young adults. We're seeking a detail-oriented, analytical, and relationship-focused Utilization Review Specialist who enjoys solving complex authorization challenges, collaborating with clinical teams, and advocating for clients' access to care.

This role is ideal for someone who thrives in a fast-paced environment, enjoys balancing independent work with team collaboration, and excels at navigating insurance requirements while ensuring clients receive the treatment they need. If you enjoy troubleshooting, communicating with multiple stakeholders, and finding creative solutions to complex problems, we'd love to hear from you.

What You'll Do

• Verify insurance benefits and eligibility prior to client admission
• Coordinate and manage authorization requests, concurrent reviews, and re-certifications with insurance providers
• Review clinical documentation and treatment plans to support medical necessity and level-of-care determinations
• Advocate for appropriate treatment authorization and prepare appeals when necessary
• Maintain accurate records of authorizations, denials, approvals, and insurer communications
• Collaborate with therapists, nursing staff, medical providers, and administrative teams to support quality care and treatment continuity
• Communicate clinical information effectively to insurance case managers and healthcare partners
• Participate in treatment team meetings and support discharge planning efforts
• Monitor client charts and documentation to ensure compliance with payer requirements
• Assist with resolving authorization discrepancies and reimbursement issues
• Respond promptly to emails, phone calls, and requests related to utilization review
• Support billing and collections processes through accurate and timely authorization management
• Contribute ideas and process improvements that enhance efficiency and treatment outcomes

What Makes Someone Successful in This Role?

You may be a great fit if you:

• Enjoy analyzing clinical information and solving complex insurance-related challenges
• Like having a balance of structure and independence in your workday
• Thrive when managing multiple priorities and working within deadlines
• Are naturally persuasive and confident when advocating for clients and treatment needs
• Enjoy troubleshooting issues, finding solutions, and moving efficiently to the next challenge
• Communicate effectively with both clinical professionals and insurance representatives
• Value collaboration while also being comfortable working independently
• Can adapt quickly to changing priorities and evolving client needs
• Enjoy variety in your work and prefer a role that keeps you engaged with different situations and stakeholders
• Use logic and critical thinking to make informed decisions
• Are resourceful, innovative, and willing to explore new approaches when obstacles arise
• Maintain professionalism and composure in high-pressure situations

What We're Looking For

Education, Training, and Experience

• Bachelor's Degree in Social Work, Psychology, Nursing, Healthcare Administration, or related field
• 13 years of experience in utilization review, medical billing, insurance authorization, healthcare administration, medical office operations, or related healthcare settings required
• LCDC, Nursing, Social Work, Counseling, or other relevant clinical licensure preferred
• Experience working in behavioral health, substance abuse treatment, mental health services, or healthcare settings preferred

Knowledge, Skills, and Abilities

• Knowledge of insurance guidelines, authorization processes, and payer requirements
• Familiarity with CPT, ICD-10 coding, DSM-5 diagnoses, and ASAM criteria preferred
• Strong problem-solving and critical-thinking skills
• Excellent verbal and written communication abilities
• Ability to prioritize multiple tasks and manage competing deadlines
• Strong organizational skills and attention to detail
• Ability to effectively handle denials, appeals, and authorization challenges
• Knowledge of medical terminology and behavioral health treatment concepts
• Customer service skills when communicating with families, clients, and insurance representatives
• Proficiency with Microsoft Office applications and electronic medical records
• Ability to work independently with minimal supervision while remaining a collaborative team member
• Understanding of confidentiality, patient rights, and healthcare compliance standards

Why Clearfork Academy?

• Meaningful work that directly impacts adolescents, young adults, and families
• Opportunity to advocate for clients and support access to life-changing treatment
• Collaborative, mission-driven treatment environment
• Fast-paced role with variety and opportunities to solve new challenges daily
• Supportive leadership team committed to excellence and professional growth
• Culture that values initiative, innovation, and continuous improvement
• Opportunity to work alongside dedicated clinical and healthcare professionals
• Organization committed to helping clients build healthier futures

If you're an organized and driven professional who enjoys analytical problem-solving, effective communication, and making a meaningful impact behind the scenes of patient care, we encourage you to apply.

Clearfork Academy

Leading Adolescents to a New Legacy