Utilization Review (UR) Specialist

Utilization Review (UR) Specialist

Location: Boca Raton, FL

Job Type: Full-time, In-Person

Pay: $60,000 – $70,000 per year, based on experience

We are seeking a full-time Utilization Review (UR) Specialist to join our team in Boca Raton, FL. We provide boutique medical billing services specifically for substance abuse and mental health treatment facilities.

This role is ideal for someone with utilization review experience, clinical knowledge, strong communication skills, and the ability to thrive in a structured, fast-paced, deadline-driven environment. The right candidate will be organized, detail-oriented, coachable, and comfortable advocating on behalf of treatment facilities with insurance carriers.

The UR Specialist will be responsible for timely payer outreach, clean documentation, consistent follow-up, and close coordination with clinical teams. This position requires reliability, attention to detail, strong documentation habits, and the ability to follow established workflows.

Responsibilities:

• Advocate on behalf of assigned facilities with insurance carriers
• Communicate effectively with clinical teams to understand patient treatment needs
• Work collaboratively with insurance providers, care managers, clinicians, admissions teams, and facility staff
• Track authorization start and end dates to help prevent lapses in coverage
• Document payer interactions, reference numbers, authorization outcomes, and determinations clearly and accurately
• Provide detailed feedback and clinical quality management support to assigned facilities
• Coordinate with clinical staff and admissions teams to ensure payer needs are met quickly
• Follow established utilization review workflows and participate in ongoing training and coaching
• Manage a caseload of approximately 30–50 patients
• Maintain professional verbal and written communication internally and externally
• Stay focused, organized, and detail-oriented throughout the day
• Support continuous improvement through accuracy, consistency, and reliable execution
• Multitask effectively while working as part of a team
• Handle reviews after standard business hours as needed

Qualifications:

• Minimum of 2 years of utilization review experience required
• Minimum of 4 years of experience in substance abuse or mental health treatment required
• 3+ years of clinical experience preferred
• Strong working knowledge of ASAM and LOCUS criteria
• Experience using EMR software required
• Kipu experience required
• High School Diploma or equivalent required
• Bachelor’s degree preferred
• Proficiency with Google Docs, Google Drive, and related Google applications
• Excellent customer service skills
• Strong verbal and written communication skills
• Ability to understand and contribute within a multidisciplinary team environment
• Strong organization, time management, and attention to detail

Ideal Candidate Traits:

• Highly coachable and willing to learn structured systems
• Deadline-aware and able to track authorization timelines carefully
• Detail-oriented with strong documentation habits
• Reliable, accountable, and consistent in daily execution
• Comfortable with repetitive follow-up work
• Able to work in a structured, high-accountability environment
• Professional, motivated, and eager to grow with the company

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Paid time off
• Employee assistance program

Work Location: In person