Senior Behavioral Health Utilization Review Specialist

Ambrosia Treatment Center; West Palm Beach (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health benefits

No co-pay or deductible

Paid time off

Job summary

Ambrosia Behavioral Health in West Palm Beach, FL is seeking a seasoned Utilization Review Specialist to join our Revenue Cycle team. You will manage initial and concurrent authorizations and coordinate with payers to ensure medical necessity and appropriate levels of care.

The ideal candidate has extensive UR experience in behavioral health, strong written and verbal communication, and a track record of effective payer negotiations and appeals.

Qualifications

• 5+ years of behavioral health UR experience.
• Experience with Detox, Residential and PHP.
• Proven ability to obtain initial and concurrent authorizations.
• Strong communication and organizational skills; healthcare payer liaison.

Responsibilities

• Submit initial authorization and concurrent reviews within payer timelines.
• Manage authorizations across Detox, Residential, and PHP for adults and adolescents.
• Review documentation to ensure medical necessity and level of care.
• Communicate with payers and manage appeals and peer-to-peer reviews.
• Maintain detailed payer communications and track authorized days.

Skills

UR experience

Payer communications

ASAM criteria

Medical necessity

Detox/Residential/PHP

Adolescent/Adult BH

Documentation accuracy

Attention to detail

Education

RN licensure

LCSW

LMHC

LMFT

Tools

MCG criteria

InterQual

payer criteria

Job description

Ambrosia Behavioral Health in West Palm Beach, FL is seeking a seasoned Utilization Review Specialist to join our Revenue Cycle team. You will manage initial and concurrent authorizations and coordinate with payers to ensure medical necessity and appropriate levels of care.

The ideal candidate has extensive UR experience in behavioral health, strong written and verbal communication, and a track record of effective payer negotiations and appeals.