Remote Utilization Review Specialist

Bradford Health Services; Birmingham (AL); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical Coverage

401(k) plan

Generous PTO

Employee Assistance Program

Job summary

Bradford Health Services is seeking an Utilization Review Specialist in Birmingham, AL. The role focuses on ensuring medical necessity and regulatory compliance by evaluating patient records, treatment plans, and clinical data to optimize care and resource use.

The position collaborates with providers, payers, and case managers to facilitate timely approvals while maintaining high standards of patient care. A background in behavioral health and familiarity with payer processes are preferred.

Qualifications

• High school diploma or equivalent required; college coursework preferred.
• Minimum 2 years of experience in behavioral healthcare or related fields.
• Working knowledge of insurance authorization processes (precertification, concurrent review, continued‑stay).
• Ability to interpret clinical documentation and communicate symptoms, impairment, risk factors, and discharge needs clearly.
• HIPAA and 42 CFR Part 2 knowledge is required or strongly preferred.

Responsibilities

• Complete admission, precertification, concurrent, continued-stay, step-down, and retrospective reviews per payer requirements.
• Obtain, document, and monitor authorizations across the continuum of care.
• Review medical records and collaborate with treatment teams to support medical necessity.
• Present clinical information to payer representatives clearly and persuasively.
• Maintain accurate authorization records in EMR, payer portals, and tracking systems.
• Monitor caseloads and deadlines; escalate barriers before reimbursement risk.

Skills

Utilization review

Behavioral health

Payer authorization

Communication skills

HIPAA compliance

Education

High school diploma or equivalent

Bachelor's degree preferred

Tools

Electronic Medical Record (EMR) systems

Payer portals

Microsoft Office

Job description

Bradford Health Services is seeking an Utilization Review Specialist in Birmingham, AL. The role focuses on ensuring medical necessity and regulatory compliance by evaluating patient records, treatment plans, and clinical data to optimize care and resource use.

The position collaborates with providers, payers, and case managers to facilitate timely approvals while maintaining high standards of patient care. A background in behavioral health and familiarity with payer processes are preferred.