Behavioral Health UR Specialist — Clinically Licensed

New Vista Behavioral Health; Cleveland (OH); On-site; USD 41,000 - 47,000; Full time

Benefits offered by this job

Medical plans

PTO & holidays

401(k) with company contribution

Tuition reimbursement

Job summary

New Vista Behavioral Health is seeking a detail-oriented Utilization Review Specialist with clinical background to support utilization review and insurance authorizations across multiple behavioral health facilities. The role requires active RN, LCSW, or LPC licensure and experience in medical necessity review.

You will coordinate authorizations, review documentation, monitor payer requirements, and collaborate with UR teams, admissions, billing, and insurance companies to promote appropriate

Qualifications

• Active clinical license required (RN, LCSW, LPC) and behavioral health experience.
• Experience with utilization review, insurance authorizations, or managed care.
• Knowledge of medical necessity criteria and payer requirements.
• Strong clinical assessment and documentation review skills.
• Excellent written and verbal communication with payers and clinical teams.
• Ability to manage multiple facilities and deadlines.
• Proficiency with electronic health records and healthcare documentation systems.

Responsibilities

• Coordinate and monitor insurance authorizations and utilization reviews across multiple behavioral health facilities.
• Conduct and coordinate initial, concurrent, and continued-stay reviews with insurance companies and managed care plans.
• Review clinical documentation to determine medical necessity and level of care.
• Track authorization dates, approved treatment days, and payer requirements.
• Communicate with payers and utilization management representatives regarding authorizations.
• Collaborate with UR teams, clinical staff, admissions, and billing to resolve issues.
• Identify denials, reduced authorizations, and barriers to reimbursement.
• Assist with denials management, appeals, and peer-to-peer review coordination.
• Provide guidance on payer requirements and documentation for utilization review.
• Maintain accurate authorization records in EHR and tracking systems.
• Monitor UR trends and assist with reporting, audits, and process improvements.
• Support compliance with HIPAA and regulatory standards.

Skills

Behavioral health knowledge

Utilization review

Insurance authorizations

Clinical assessment

HIPAA/compliance

Written and verbal communication

Education

RN license

LCSW license

LPC license

Tools

Electronic Health Records

Microsoft Office

Job description

New Vista Behavioral Health is seeking a detail-oriented Utilization Review Specialist with clinical background to support utilization review and insurance authorizations across multiple behavioral health facilities. The role requires active RN, LCSW, or LPC licensure and experience in medical necessity review.

You will coordinate authorizations, review documentation, monitor payer requirements, and collaborate with UR teams, admissions, billing, and insurance companies to promote appropriate