Behavioral Utilization Review Specialist

Job Description

Job Description

Behavioral Utilization Review Specialist Position Summary

The Behavioral Utilization Review Specialist is responsible for coordinating new client referrals, supporting the prior authorization process, maintaining referral records, and completing routine Medicaid eligibility screenings. This position works closely with discharge planners, Program Administrators, Clinical Directors, and other members of the referral and billing teams.

The ideal candidate will be highly organized, detail-oriented, comfortable reviewing behavioral health documentation, and able to manage multiple deadlines across all Gardens of Arkansas locations.

Essential Duties and Responsibilities- Assist the Chief Revenue Officer with the following:

• Clinical Review & Assessment: Evaluate care related to mental health before, and during services to determine medical appropriateness

• Prior Authorization Reviews: Assess and submit requests for behavioral health services to ensure they meet regulatory and clinical criteria

• Concurrent Review: Monitor behavioral health records to assess treatment needs, and discharge planning.

Preferred Qualifications

• Education : Bachelor’s degree in nursing, social work, counseling, or related field; Master’s degree preferred for behavioral health clinicians

• Licensure : LMHC, LPC, LMHP, or LPN ,RN licensure.

• Experience : 2–4 years in utilization review, case management, or related behavioral health roles preferred

Knowledge, Skills, and Abilities

• Strong understanding of medical and behavioral health terminology

• Proficiency in data analysis and regulatory compliance.

• Excellent verbal and written communication and collaboration skills with healthcare teams and providers.

• Excellent organizational skills and ability to prioritize a workload

• Some Billing knowledge

Additional Responsibilities

· Participate in meetings, training, and process-improvement activities as required.

· Provide administrative support to the referral, clinical, billing, and leadership teams as needed.

· Perform other duties as assigned.

Physical and Work Requirements

· Prolonged periods of sitting and working at a computer.

· Ability to communicate by telephone, email, video conferencing, and in person.

· Ability to organize, review, scan, upload, and maintain electronic and paper records.

· Ability to work in a fast-paced environment with frequent deadlines and interruptions.

Equal Employment Opportunity

The Gardens of Arkansas is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by applicable law.