Per Diem Utilization Review Specialist - Behavioral Health

The Florida House; Oregon; Hybrid; USD 55,000 - 96,000; Part time

Benefits offered by this job

Medical, Dental, and Vision Insurance

401(k) Retirement Plan

Generous PTO & Vacation Time

Employee Assistance Program

Opportunities for Professional Growth

Free CEU's

Free CPR Certification

Free CPI Certification

Job summary

FHE Health in the United States is seeking an experienced Utilization Review (UR) Specialist to manage clinical authorization processes, ensuring timely and accurate communication with insurance payers and adherence to payer guidelines. This role supports patient access to behavioral health treatment by securing initial and continued-stay authorizations while preventing denials.

This per diem, as-needed position focuses on maximizing reimbursement, maintaining compliance, and collaborating with

Qualifications

• Bachelor's degree in Nursing, Social Work, Behavioral Health or related field.
• 2-3 years of utilization review experience in behavioral health, addiction treatment, or managed care.
• Strong understanding of ASAM criteria, LOCUS, DSM-5, diagnostic standards, and documentation requirements.
• Excellent clinical summarization and documentation review skills.
• Strong communication with clinical teams and insurance reviewers.
• Ability to problem-solve, escalate appropriately, and manage time-sensitive deadlines.
• High attention to detailed accuracy.

Responsibilities

• Responsible for managing all clinical authorization processes to ensure timely, accurate, and compliant communication with insurance payers.
• Supports patient access to treatment by securing initial and continued-stay authorizations, preventing avoidable denials, and collaborating with clinical teams to ensure documentation reflects medical necessity according to payer guidelines.
• The UR Specialist helps maximize reimbursement, maintain compliance, and support quality patient care throughout the behavioral health and addiction treatment continuum.

Skills

Utilization review experience

ASAM criteria knowledge

LOCUS

DSM-5 knowledge

Documentation review

Clinical summarization

Communication with clinical teams

Time management

Attention to detail

Education

Bachelor's degree in Nursing, Social Work, Behavioral Health or related field

Job description

FHE Health in the United States is seeking an experienced Utilization Review (UR) Specialist to manage clinical authorization processes, ensuring timely and accurate communication with insurance payers and adherence to payer guidelines. This role supports patient access to behavioral health treatment by securing initial and continued-stay authorizations while preventing denials.

This per diem, as-needed position focuses on maximizing reimbursement, maintaining compliance, and collaborating with