Corporate UR Specialist

Job Type: Full-time Pay Range: $24 - $32hr Location: 10123 Alliance Road, Cincinnati, Ohio 45242 Job Summary New Vista Behavioral Health is seeking a detail-oriented and clinically experienced Corporate Utilization Review Specialist to support utilization review and insurance authorization processes across multiple behavioral health facilities. Candidates must hold an active clinical license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), LSW / LCSW The Corporate Utilization Review Specialist will coordinate insurance authorizations, review clinical documentation for medical necessity, monitor payer requirements, and support timely reimbursement for behavioral health and substance use disorder treatment services. This position will collaborate with facility-based utilization review teams, clinical leadership, admissions, billing, and insurance companies to promote appropriate levels of care, prevent avoidable denials, and maintain compliance with payer requirements. The ideal candidate has a clinical background, strong knowledge of behavioral health treatment, and experience with utilization review, insurance authorizations, or managed care. Essential Duties and Responsibilities Coordinate and monitor insurance authorizations and utilization reviews across multiple behavioral health facilities. Conduct and coordinate initial, concurrent, and continued-stay reviews with commercial insurance companies, managed care organizations, and government-funded health plans, as applicable. Review clinical documentation to determine whether it supports medical necessity and continued treatment at the requested level of care. Track authorization dates, approved treatment days, review deadlines, and payer-specific requirements. Communicate with insurance companies, utilization management representatives, and clinical reviewers regarding authorizations and additional documentation requests. Collaborate with facility UR teams, clinical staff, admissions, and billing to resolve authorization issues and prevent gaps in coverage. Identify and escal potential denials, reduced authorizations, expired approvals, and other barriers to reimbursement. Assist with denial management, appeals, reconsiderations, and peer-to-peer review coordination. Provide clinical and operational guidance to facility teams regarding payer requirements, medical necessity documentation, and utilization review processes. Maintain accurate authorization records, review outcomes, and payer communications in electronic health records and tracking systems. Monitor utilization review trends and assist with reporting, audits, and process improvement initiatives. Support compliance with organizational policies, HIPAA, payer requirements, and applicable regulatory standards. Perform other related duties as assigned. Required Qualifications Acceptable clinical licenses may include RN, LCSW, LPC Experience in behavioral health, substance use disorder treatment, utilization review, utilization management, or a related healthcare setting. Knowledge of medical necessity criteria, insurance authorization procedures, and concurrent review processes. Strong clinical assessment, documentation review, and critical-thinking skills. Excellent written and verbal communication skills, including the ability to communicate effectively with insurance payers and multidisciplinary clinical teams. Strong organizational skills and the ability to manage multiple priorities, facilities, and deadlines. Proficiency with electronic health records, Microsoft Office, and healthcare documentation systems. Ability to maintain patient confidentiality and comply with HIPAA requirements. Preferred Qualifications Previous experience in behavioral health utilization review or insurance authorization. Experience supporting multiple facilities in a corporate or centralized utilization review department. Experience with inpatient psychiatric, residential treatment, partial hospitalization (PHP), intensive outpatient (IOP), or substance use disorder programs. Experience with insurance denials, appeals, peer-to-peer reviews, and managed care organizations. Experience monitoring utilization review performance metrics and supporting process improvement initiatives. Why You'll Love It Here (Full-Time Benefits) Multiple medical plan options, Vista Wellness (physician/pharmacy), Dental, Vision Generous PTO and paid holidays 401(k) with company contribution; Life and disability coverage Tuition reimbursement up to $15,000 and student loan assistance programs #J-18808-Ljbffr NewVista Behavioral Health