Utilization Review Specialist

Utilization Review (UR) Specialist

Location: Open to candidates near Wyomissing PA & Chadds Ford PA (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

Open to candidates near Chadds Ford, PA (19317) and Wyomissing PA (19610) 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.