Remote Utilization Review Specialist – Behavioral Health

Addiction And Mental Health Services; Birmingham (AL); Híbrido; USD 60.000 - 70.000; Jornada completa

Descripción de la vacante

Bradford Health Services seeks an experienced Utilization Review Specialist to join our Birmingham-based team. You will evaluate patient records, treatment plans, and clinical data to determine medical necessity and appropriate level of care while ensuring regulatory compliance.

You will collaborate with physicians, case managers, and insurers to obtain authorizations, monitor deadlines, and support high-quality patient care across facilities in the Southeast.

Formación

• Minimum 2 years in behavioral healthcare or related.
• Ability to interpret clinical documentation and communicate clearly.
• Knowledge of HIPAA and 42 CFR Part 2.
• Experience with insurance authorization processes.

Responsabilidades

• Complete admission, precertification, concurrent, continued-stay, step-down, and retrospective reviews.
• Obtain and monitor authorizations across the continuum of care.
• Review medical records to support medical necessity and requested level of care.
• Present clinical information to payer representatives using medical-necessity criteria.
• Maintain authorization records in EMR, payer portals, tracking systems, and other applications.
• Monitor caseloads and deadlines; escalate barriers before reimbursement risk.
• Coordinate with clinical and case-management teams for transitions and discharge planning.
• Prepare concise case summaries for peer reviews and appeals.
• Follow up on payer correspondence and adverse determinations.

Conocimientos

Utilization Review

Behavioral Health

Payer Authorization

HIPAA Knowledge

Communication Skills

EMR Systems

Case Management

Attention to Detail

Regulatory Compliance

Educación

Bachelor's degree

Herramientas

Payer Portals

MS Office

Descripción del empleo

Bradford Health Services seeks an experienced Utilization Review Specialist to join our Birmingham-based team. You will evaluate patient records, treatment plans, and clinical data to determine medical necessity and appropriate level of care while ensuring regulatory compliance.

You will collaborate with physicians, case managers, and insurers to obtain authorizations, monitor deadlines, and support high-quality patient care across facilities in the Southeast.