Clinical Utilization & Authorization Specialist

Unison Health; Toledo (OH); Hybrid; USD 65,000 - 80,000; Full time

Benefits offered by this job

PTO starting at 16 days/year

Medical with federal minimum deduct

Dental and vision coverage

Retirement planning and employer match

Job summary

Unison Health seeks a Clinical Utilization (CU) Specialist to support prior authorization coordination, preparing clinical summaries and tracking requests. The role collaborates with clinical staff and Billing to ensure timely submissions and accurate documentation, while contributing to quality improvement efforts and payer communications.

The position emphasizes compliance, data analysis, and education to promote high-quality client care within a mission-driven, staff-supportive environment.

Qualifications

• Bachelor's degree in a mental health-related field, business management, or health care administration preferred.
• An associate's degree with relevant experience may be considered.
• Minimum of 3 years of clinical experience in the mental health field; quality improvement experience preferred.
• Licensed LSW, LPC, LISW, LPCC, RN preferred.
• Proficiency in Microsoft Word, PowerPoint, Excel (including data entry, formulas, and pivot tables).
• Ability to handle confidential information with discretion.

Responsibilities

• Review clinical documentation and prepare comprehensive clinical summaries to support initial and ongoing prior authorization requests.
• Collaborate with Billing to ensure authorization requests are complete and submitted within required timeframes.
• Monitor and track authorizations, including approvals, denials, expiration dates, requested units, and follow-up.
• Track denials and appeals, including outcomes and trends, and assist in gathering documentation for appeals.
• Maintain knowledge of authorization requirements, timelines, and documentation standards across Medicaid plans and other payers.
• Analyze data related to authorizations, denials, appeals, turnaround times, and payer trends to identify challenges and support improvement.
• Develop relationships with clinical leaders to obtain information needed for authorization requests.
• Assist with chart reviews and utilization review activities related to documentation and medical necessity.
• Collaborate with Shelby, clinical leadership, Billing, and Quality Improvement to address gaps and implement solutions.

Skills

Analytical skills

Problem solving

Attention to detail

Communication skills

Discretion with confidential info

Team collaboration

Time management

Education

Bachelor's degree in health field

Associate degree with relevant experience

Licensure: LSW/LPC/LISW/LPCC/RN preferred

Tools

Microsoft Word

PowerPoint

Excel (data entry, formulas, pivot tables)

Job description

Unison Health seeks a Clinical Utilization (CU) Specialist to support prior authorization coordination, preparing clinical summaries and tracking requests. The role collaborates with clinical staff and Billing to ensure timely submissions and accurate documentation, while contributing to quality improvement efforts and payer communications.

The position emphasizes compliance, data analysis, and education to promote high-quality client care within a mission-driven, staff-supportive environment.