Hybrid/Remote Utilization Review Pro - Compliance Focus

Diversified Treatment Alternative Centers; Chadds Ford Township (PA); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

401(k)

Health, Dental, and Vision Insurance

Health Savings Account

Paid Time Off

Life and Disability Insurance

Employee Assistance Program

Referral Program

Job summary

Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented Utilization Review Specialist to ensure authorization accuracy and regulatory compliance for our behavioral health programs. This role collaborates with Clinical, Admissions, and Revenue Cycle teams to minimize denials and support timely reimbursement.

The position offers flexible hybrid or remote options, with a focus on maintaining medical necessity, efficient authorizations, and thorough documentation across EHR and

Qualifications

• Bachelor's degree in a related field is required.
• 1–3 years of experience in utilization review, case management, or behavioral health revenue cycle.
• Strong understanding of medical necessity and authorization processes.
• Excellent attention to detail and analytical skills.
• Strong written and verbal communication skills.

Responsibilities

• Conduct initial, concurrent, and continued stay utilization reviews.
• Submit, track, and manage authorizations and reauthorizations.
• Communicate authorization updates with clinical and admissions teams.
• Maintain accurate documentation in EHR and billing systems.
• Perform ongoing eligibility verification for active clients.
• Identify coverage changes and communicate impacts to appropriate teams.
• Review clinical documentation for medical necessity and compliance.
• Collaborate with clinicians to address documentation gaps.
• Support denial prevention and revenue cycle optimization.
• Assist with appeals and utilization-related inquiries.
• Participate in audits, quality improvement initiatives, and compliance reviews.
• Stay current with payer requirements and regulatory updates.

Skills

Attention to detail

Analytical skills

Written and verbal communication

Collaboration across teams

Hybrid/remote work adaptability

Education

Bachelor's degree in Healthcare Administration, Nursing, Social Work, Psychology, or related field

Tools

EHR systems

Billing workflows

Job description

Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented Utilization Review Specialist to ensure authorization accuracy and regulatory compliance for our behavioral health programs. This role collaborates with Clinical, Admissions, and Revenue Cycle teams to minimize denials and support timely reimbursement.

The position offers flexible hybrid or remote options, with a focus on maintaining medical necessity, efficient authorizations, and thorough documentation across EHR and