Utilization Review (UR) Specialist

Job Description

Job Description

Are you experienced in psychiatric care and passionate about ensuring patients receive the right level of care at the right time? We are seeking a dedicated Utilization Review (UR) Specialist to join our team and support our mission of delivering quality behavioral health services. 

What You’ll Do 

• Conduct utilization reviews to determine medical necessity and appropriate levels of care for psychiatric and behavioral health patients. 

• Collaborate with physicians, nurses, and treatment teams to develop individualized care plans that align with payer requirements. 

• Communicate with insurance companies, providing clinical documentation and justifications to support ongoing care. 

• Monitor patient progress and identify opportunities for earlier discharge or transitions to alternative levels of care. 

• Maintain accurate and timely documentation in compliance with state, federal, and organizational standards. 

• Serve as a resource for clinical teams regarding payer guidelines, authorizations, and managed care processes. 

What You’ll Bring 

• Required: Experience working in psychiatric, behavioral health, or mental health settings. 

• Strong knowledge of managed care, payer guidelines, and utilization management processes. 

• Excellent clinical assessment, critical thinking, and communication skills. 

• Ability to collaborate across interdisciplinary teams and interact with external stakeholders. 

• Nursing license (RN, LPN) preferred, but candidates with strong behavioral health utilization review experience will also be considered. 

Why Join Us? 

• Be part of a mission-driven organization focused on patient-centered care. 

• Work alongside a supportive and collaborative clinical team. 

• Competitive pay and comprehensive benefits package. 

• Opportunities for growth in a growing behavioral health network.