Behavioral Health Utilization Review Specialist

Socket.dev; Alabama; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical Coverage

Retirement Benefits

Generous PTO

Student Loan Repayment

Job summary

Bradford Health Services is looking for an Utilization Review Specialist to ensure medical necessity and regulatory compliance across patient records and treatment plans. You will collaborate with clinical teams, payers, and leadership to secure timely authorizations and optimize patient outcomes.

The role requires strong communication, attention to detail, and knowledge of HIPAA and payer guidelines. Join a team dedicated to evidence-based addiction treatment and accountable, patient-centered

Qualifications

• Bachelor's degree in Social Work, Psychology, Counseling, Nursing, Healthcare Administration, Health Information Management, or related healthcare discipline is preferred.

Responsibilities

• Complete admission, precertification, concurrent, continued-stay, step-down, and retrospective reviews per payer requirements.
• Obtain, document, and monitor authorizations across continuum of care with all details.
• Review medical records and collaborate with treatment team to support medical necessity.
• Present clinical information to payer representatives clearly and persuasively.
• Maintain accurate authorization records in EMR, payer portals, and tracking systems.
• Monitor caseloads and deadlines; escalate barriers before reimbursement risk.
• Identify documentation gaps and communicate needs without altering clinical records.
• Coordinate transitions and discharge planning to support continuity of care.
• Recognize adverse determinations and escalate for peer review or appeals.
• Prepare case summaries for peer reviews and appeals.
• Review payer correspondence and follow-up within deadlines.
• Participate in denial review, audits, training, and performance-improvement initiatives.
• Follow standardized utilization review policies across facilities and states.
• Maintain knowledge of payer policies, medical necessity criteria, and regulatory standards.
• Collaborate with UR leadership, clinical teams, and Revenue Cycle partners.
• Protect patient privacy and ensure HIPAA compliance.

Skills

Communication skills

Attention to detail

Time management

Professional judgment

HIPAA knowledge

Education

Bachelor's degree in Social Work, Psychology, Counseling, Nursing, Healthcare Administration, Health Information Management, or related healthcare discipline

Tools

Microsoft Office

EMR systems

Payer portals

Job description

Bradford Health Services is looking for an Utilization Review Specialist to ensure medical necessity and regulatory compliance across patient records and treatment plans. You will collaborate with clinical teams, payers, and leadership to secure timely authorizations and optimize patient outcomes.

The role requires strong communication, attention to detail, and knowledge of HIPAA and payer guidelines. Join a team dedicated to evidence-based addiction treatment and accountable, patient-centered