Clinical Utilization Review Specialist

Canyon Vista Recovery Center; Mesa (AZ); On-site; USD 33,000 - 40,000; Full time

Job summary

Canyon Vista Recovery Center in Mesa, Arizona is seeking a Utilization Review Specialist to manage admissions, reviews, and discharge planning using clinically valid criteria. This role collaborates with insurers and physicians to obtain approvals and ensures accurate medical necessity documentation.

The ideal candidate has a background in substance abuse settings, experience with utilization review, and the ability to coordinate pre-certifications and appeal processes.

Qualifications

• High School diploma or equivalent required.
• Bachelor's degree in social work, behavioral or mental health, or related health field preferred.
• One+ year direct clinical experience in a substance abuse setting required; ASAM experience preferred.
• At least one year experience in utilization review preferred.

Responsibilities

• Performs admissions, concurrent, continued stay, and retrospective reviews using established criteria.
• Communicates with insurers (HMOs) for approvals and provides concise clinical information.
• Coordinates with physicians and staff regarding utilization trends and issues.
• Appeals denials and coordinates appeal process with providers and payers.
• Assists admissions with pre-certifications; conducts pre/post admission benefit verification.
• Maintains documentation on utilization management and charts.
• Supports staff training on documentation and medical necessity updates.
• Participates in discharge planning and length-of-stay monitoring.

Skills

Utilization Review

Documentation

Communication

Appeals

Education

Bachelor's degree

High School diploma

Job description

Canyon Vista Recovery Center in Mesa, Arizona is seeking a Utilization Review Specialist to manage admissions, reviews, and discharge planning using clinically valid criteria. This role collaborates with insurers and physicians to obtain approvals and ensures accurate medical necessity documentation.

The ideal candidate has a background in substance abuse settings, experience with utilization review, and the ability to coordinate pre-certifications and appeal processes.