Behavioral Health Utilization Review Specialist

New Vista Behavioral Health; Cincinnati (OH); On-site; USD 33,000 - 44,000; Full time

Benefits offered by this job

Medical plan options

PTO & paid holidays

401(k) with company contribution

Tuition reimbursement

Job summary

New Vista Behavioral Health is seeking a detail-oriented Corporate Utilization Review Specialist to support utilization review and insurance authorization processes across multiple behavioral health facilities.

Candidates must hold an active clinical license as an RN or LCSW, LPC, or LSW/LCSW. The role coordinates authorizations, reviews medical necessity, and ensures compliant, timely reimbursement for behavioral health services.

Qualifications

• Active clinical licenses (RN, LCSW, LPC) required.
• Experience in behavioral health, substance use treatment, UR or managed care.
• Knowledge of medical necessity criteria and insurance authorization procedures.
• Strong documentation review, assessment, and critical-thinking skills.
• Excellent written and verbal communication with payers and clinical teams.
• Ability to manage multiple facilities, deadlines, and priorities.
• Proficiency with electronic health records and healthcare documentation systems.
• Maintain patient confidentiality and HIPAA compliance.

Responsibilities

• Coordinate and monitor authorizations across multiple behavioral health facilities.
• Conduct initial, concurrent, and continued-stay reviews with insurers.
• Review clinical docs to support medical necessity for care.
• Track authorization dates, approved days, and payer requirements.
• Communicate with payers and reviewers for documents requests.
• Collaborate with UR teams, admissions, billing to resolve issues.
• Identify potential denials and assist with appeals and peer reviews.
• Provide guidance on payer requirements and documentation practices.
• Maintain accurate records in EHRs and tracking systems.
• Support audits, reporting, and process improvements.

Skills

RN license

LCSW license

LPC license

Behavioral health experience

Medical necessity knowledge

Communication skills

HIPAA compliance

Job description

New Vista Behavioral Health is seeking a detail-oriented Corporate Utilization Review Specialist to support utilization review and insurance authorization processes across multiple behavioral health facilities.

Candidates must hold an active clinical license as an RN or LCSW, LPC, or LSW/LCSW. The role coordinates authorizations, reviews medical necessity, and ensures compliant, timely reimbursement for behavioral health services.