Utilization Review Specialist

Job Description

Job Description

Description:

Utilization Review Specialist

Full-Time- must be able to work a few weekends per month

Location: Remote

Preferred Residence: Candidates residing in Florida, Tennessee, Texas, Virginia, South Carolina, or New Jersey are strongly encouraged to apply.

Job Type: Part-Time

Schedule:

• 16–24 hours per week
• Weekend availability required
• Ideal schedule is Friday through Monday, working 2–3 days within that timeframe
• Schedule may vary based on business needs

Recovery Unplugged is a national leader in drug and alcohol addiction treatment, offering an innovative, evidence-based approach that integrates the healing power of music into recovery. With treatment centers across Florida, Texas, Virginia, New Jersey, South Carolina, and Tennessee, we are committed to delivering compassionate care that helps individuals build lasting recovery.

Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This position plays a critical role in ensuring patients receive the appropriate level of care by obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams throughout the treatment process.

The ideal candidate has prior experience in behavioral health utilization review, understands managed care guidelines, and is comfortable advocating for patients with insurance providers.

• Conduct utilization reviews for admissions and continued stays to establish medical necessity and obtain insurance authorizations.
• Review clinical documentation to support the appropriate level of care and length of stay.
• Present clinical information to insurance companies and managed care representatives to obtain or extend authorizations.
• Communicate with insurance case managers regarding benefits, coverage, and authorization status.
• Collaborate with clinical staff to ensure documentation meets payer requirements.
• Provide guidance to treatment teams regarding insurance criteria, continued stay requirements, and discharge planning.
• Maintain accurate, timely, and organized documentation in accordance with company policies and regulatory standards.
• Work collaboratively with multidisciplinary teams to support quality patient care and reimbursement.
• Protect patient confidentiality and comply with all HIPAA and organizational policies.
• Perform other duties as assigned.

• $40k-50k annually, depending on experience, qualifications, and whether the selected candidate works a 2-day or 3-day weekend schedule.
• Benefits may be available based on eligibility.

Join a team that's transforming addiction treatment through compassionate, evidence-based care and the healing power of music. If you're passionate about advocating for patients and navigating the utilization review process, we'd love to hear from you.

Recovery Unplugged is an Equal Opportunity Employer.

• Previous experience in Utilization Review, Managed Care, Behavioral Health, or a related healthcare setting required.
• Experience working with substance use disorder or behavioral health treatment programs is strongly preferred.
• Strong knowledge of insurance authorization processes and reimbursement practices.
• Excellent verbal and written communication skills.
• Strong organizational skills with the ability to manage multiple cases simultaneously.
• Proficiency with electronic medical records (EMR) systems and Microsoft Office.
• Current clinical licensure is preferred but not required. Candidates with significant utilization review experience will be considered.