Remote Behavioral Health Utilization Review Specialist

Bradford Health Services; Birmingham (AL); Remote; USD 60,000 - 70,000; Full time

Job summary

Bradford Health Services is seeking an Utilization Review Specialist in Birmingham, AL. The role ensures medical necessity and regulatory compliance across patient care, collaborating with providers, insurers, and case managers to optimize outcomes.

The candidate will review records, treatment plans, and data to support authorization decisions, while maintaining accurate documentation and meeting payer deadlines. A strong focus on HIPAA/privacy and quality assurance is essential.

Qualifications

• Minimum 2 years of experience in behavioral healthcare or utilization review.
• Ability to interpret clinical documentation and communicate needs clearly.
• Strong knowledge of insurance authorization processes and payer requirements.
• Commitment to patient confidentiality and regulatory standards.

Responsibilities

• Review admissions, precertifications, concurrent and continued-stay reviews per payer requirements.
• Obtain and monitor authorizations across the continuum of care.
• Collaborate with treatment teams to support medical necessity and appropriate care levels.

Skills

Verbal communication

Written communication

Attention to detail

Team collaboration

HIPAA compliance

Education

High school diploma or equivalent

Bachelor's degree in related healthcare field

Tools

Microsoft Office

EMR systems

Payer portals

Job description

Bradford Health Services is seeking an Utilization Review Specialist in Birmingham, AL. The role ensures medical necessity and regulatory compliance across patient care, collaborating with providers, insurers, and case managers to optimize outcomes.

The candidate will review records, treatment plans, and data to support authorization decisions, while maintaining accurate documentation and meeting payer deadlines. A strong focus on HIPAA/privacy and quality assurance is essential.