Healthcare Utilization & Authorization Specialist

Clean Recovery Centers; Tampa (FL); Hybrid; USD 45,000 - 60,000; Full time

Job summary

Clean Recovery Centers is seeking an Utilization Review Specialist in Tampa. The role focuses on managing revenue flow by coordinating with insurance providers for precertifications, concurrent authorizations, and ongoing referrals.

You will review medical necessity, collect documentation, and support reimbursement decisions. The ideal candidate has ASAM/LOCUS knowledge, strong communication skills, and experience navigating EMR systems with attention to detail.

Qualifications

• Must have high school diploma or equivalent.
• Experience with ASAM, LOCUS, InterQual and treatment planning for SUD and MH.
• Ability to interpret medical and behavioral health terminology.
• Strong communication, organizational and interpersonal skills.

Responsibilities

• Review medical necessity and records to support authorizations.
• Call insurance providers for precertification and concurrent authorizations.
• Attend team meetings and train clinicians on data needs.
• Maintain tracking documents and transfer information to billing.
• Utilize insurance portals (Payspan, Zelis) and MS Word/Outlook/Excel/Adobe.
• Identify reimbursement trends and report findings to supervisor.
• Address denials and obtain additional medical history as needed.
• Communicate treatment plans to payors for ongoing authorization.

Skills

ASAM criteria

LOCUS criteria

InterQual criteria

Communication skills

Attention to detail

Medical terminology

Organizational skills

Education

High School Diploma or equivalent

Tools

EMR systems

Microsoft Word

Outlook

Excel

Adobe

Job description

Clean Recovery Centers is seeking an Utilization Review Specialist in Tampa. The role focuses on managing revenue flow by coordinating with insurance providers for precertifications, concurrent authorizations, and ongoing referrals.

You will review medical necessity, collect documentation, and support reimbursement decisions. The ideal candidate has ASAM/LOCUS knowledge, strong communication skills, and experience navigating EMR systems with attention to detail.