Behavioral Health UR Specialist (RN/LCSW/LPC)

New Vista Behavioral Health; Ohio; On-site; USD 68,770,000 - 91,693,000; Full time

Benefits offered by this job

Medical plans

PTO and paid holidays

401(k) with company contribution

Tuition reimbursement

Job summary

New Vista Behavioral Health is seeking a detail-oriented Corporate Utilization Review Specialist with active clinical licensure (RN, LCSW, or LPC) to support utilization review and insurance authorizations across multiple behavioral health facilities.

Responsibilities include coordinating authorizations, reviewing medical necessity, and ensuring payer compliance. Ideal candidates have behavioral health experience and strong documentation and communication skills.

Qualifications

• Active clinical license in RN, LCSW, or LPC.
• Experience in behavioral health and utilization review.
• Knowledge of medical necessity criteria and insurance authorization procedures.
• Strong communication and organizational skills.
• Proficiency with EHRs and healthcare documentation systems.

Responsibilities

• Coordinate insurance authorizations and utilization reviews across multiple facilities.
• Conduct initial, concurrent, and continued-stay reviews with payers.
• Review clinical documentation for medical necessity and level of care.
• Track authorization dates, review deadlines, and payer requirements.
• Communicate with insurers and UR teams about authorizations and documentation requests.
• Collaborate with UR, admissions, billing, and clinical staff to resolve issues.
• Identify and escalate potential denials and barriers to reimbursement.
• Assist with denials management, appeals, and peer-to-peer review coordination.
• Provide guidance on payer requirements and documentation standards.
• Maintain accurate authorization records and payer communications.
• Monitor UR trends and assist with reporting and process improvement.
• Ensure compliance with HIPAA and organizational policies.

Skills

RN

LCSW

LPC

Tools

EHR systems

Microsoft Office

Job description

New Vista Behavioral Health is seeking a detail-oriented Corporate Utilization Review Specialist with active clinical licensure (RN, LCSW, or LPC) to support utilization review and insurance authorizations across multiple behavioral health facilities.

Responsibilities include coordinating authorizations, reviewing medical necessity, and ensuring payer compliance. Ideal candidates have behavioral health experience and strong documentation and communication skills.