Remote Utilization Review Specialist - Behavioral Health

MN Adult & Teen Challenge; Minneapolis (MN); Hybrid; USD 37,000 - 41,000; Full time

Job summary

Minnesota Adult & Teen Challenge is seeking an Utilization Review Coordinator to manage insurance authorizations for treatment services. This role collaborates with admissions, counselors, and payers to ensure timely authorizations and compliance with payer and regulatory standards.

Responsibilities include submitting authorization requests, monitoring status, and guiding documentation to support medical necessity and level of care. Must stay current with payer rules and HIPAA compliance.

Qualifications

• Two years of experience in utilization review, admissions, healthcare reimbursement, insurance authorization, behavioral health, or related healthcare setting.
• Knowledge of DSM-5-TR, ASAM Criteria, and payer requirements preferred.
• Must complete DHS background study and maintain eligibility.

Responsibilities

• Obtains and maintains insurance authorizations for treatment services.
• Submits initial authorization requests, continued stay reviews, and reauthorization requests.
• Monitors authorization status and initiates renewals to prevent interruptions in care.
• Communicates determinations and payer requirements to clinical and operational teams.
• Collaborates with counselors, nursing staff, and leadership to support medical necessity.

Skills

Utilization review

Insurance authorization

Healthcare reimbursement

Behavioral health

DSM-5-TR knowledge

Credible EMR

One year sobriety

Strong communication

Organizational skills

Education

Associate's or Bachelor's degree in healthcare

High school diploma or GED

Tools

Credible EMR

Job description

Minnesota Adult & Teen Challenge is seeking an Utilization Review Coordinator to manage insurance authorizations for treatment services. This role collaborates with admissions, counselors, and payers to ensure timely authorizations and compliance with payer and regulatory standards.

Responsibilities include submitting authorization requests, monitoring status, and guiding documentation to support medical necessity and level of care. Must stay current with payer rules and HIPAA compliance.