Hybrid Behavioral Health Utilization Specialist

Ampian HR; Draper (UT); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Competitive salary

Comprehensive benefits

Growth opportunities

Job summary

Row Partners is seeking a Behavioral Health Utilization Management Specialist in Utah to bridge clinical care and insurance coverage and ensure timely access to services for patients.

You will review records, collaborate with clinicians and payers, and conduct clinical reviews across inpatient, outpatient, and residential settings while staying current with industry standards and regulatory guidelines. The role requires attention to detail, strong communication, and a patient-centered approach.

Qualifications

• Experience reviewing medical records to determine medical necessity and appropriateness.
• Collaborate with clinicians, medical staff, and insurance providers to ensure timely access to services.
• Understanding of behavioral health diagnoses and treatment criteria.

Responsibilities

• Champion patient care by reviewing records to determine medical necessity and appropriateness of behavioral health services.
• Collaborate with clinicians and insurance providers to ensure timely access to services.
• Conduct clinical reviews for inpatient, outpatient, and residential behavioral health services.
• Ensure quality of care by reviewing treatment plans and discharge plans.
• Support evidence-based treatment by applying clinical criteria and guidelines to approve and recommend necessary care.
• Stay ahead of industry standards, insurance requirements, and treatment protocols.
• Advocate for patients by facilitating communication between providers, patients, and payers.
• Document with precision for utilization reviews, audits, and compliance needs.

Skills

Utilization management

Behavioral health

Medical records review

Insurance coordination

EHR proficiency

Tools

ASAM

MCG

InterQual

Job description

Row Partners is seeking a Behavioral Health Utilization Management Specialist in Utah to bridge clinical care and insurance coverage and ensure timely access to services for patients.

You will review records, collaborate with clinicians and payers, and conduct clinical reviews across inpatient, outpatient, and residential settings while staying current with industry standards and regulatory guidelines. The role requires attention to detail, strong communication, and a patient-centered approach.