Behavioral Health Utilization Review Pro

Remote Jobs; Birmingham (AL); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical Coverage

401(k) plan

Generous PTO

Job summary

Bradford Health Services seeks a dedicated Utilization Review Specialist to ensure medically necessary and compliant care across the continuum. You will evaluate patient records, treatment plans, and clinical data to authorize appropriate levels of care, collaborating with providers, payers, and case managers to optimize outcomes.

The role emphasizes HIPAA compliance, accurate documentation, and timely payer communications, contributing to sustainable, high-quality addiction treatment services

Qualifications

• Minimum 2 years of experience in behavioral healthcare, utilization review, or closely related function.
• Working knowledge of insurance authorization processes including precertification, concurrent review, continued-stay review, and payer follow-up.
• Ability to interpret clinical documentation and clearly communicate symptoms, functional impairment, risk factors, and treatment needs.
• Demonstrated ability to manage multiple cases and deadlines with accuracy and escalation when needed.

Responsibilities

• Complete admission, precertification, concurrent, continued-stay, step-down, and retrospective reviews per payer requirements.
• Obtain, document, and monitor authorizations across the continuum of care.
• Review medical records and collaborate with the treatment team to support medical necessity.
• Present clinical information to payer representatives using medical-necessity criteria and payer guidelines.
• Maintain accurate authorization records in EMR, payer portals, and tracking systems.
• Coordinate with clinical and case-management teams for transitions and discharge planning.
• Identify documentation gaps and communicate needs to the appropriate clinician without altering records.
• Participate in denial review, root-cause analysis, and quality-improvement initiatives.

Skills

Behavioral health experience

Communication skills

HIPAA knowledge

Multitasking

Education

Bachelor's degree in a related field

Tools

EMR systems

Payer portals

Microsoft Office

Job description

Bradford Health Services seeks a dedicated Utilization Review Specialist to ensure medically necessary and compliant care across the continuum. You will evaluate patient records, treatment plans, and clinical data to authorize appropriate levels of care, collaborating with providers, payers, and case managers to optimize outcomes.

The role emphasizes HIPAA compliance, accurate documentation, and timely payer communications, contributing to sustainable, high-quality addiction treatment services