Strategic Utilization Review Specialist

Solution Based Therapeutics LLC

Boca Raton (FL)

On-site

USD 60,000 - 70,000

Full time

7 days ago

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Job summary

Solution Based Therapeutics LLC in Boca Raton, FL is seeking a full-time Utilization Review (UR) Specialist to support treatment facilities with medical billing services, focusing on substance use and mental health care. The ideal candidate has UR experience, clinical knowledge, strong communication, and the ability to thrive in a structured, deadline-driven environment.

You will advocate with insurance carriers, maintain precise documentation, and coordinate with clinical teams to ensure timely

Qualifications

Minimum of 2 years of utilization review experience required.
Minimum of 4 years of experience in substance abuse or mental health treatment required.
3+ years of clinical experience preferred.
Strong working knowledge of ASAM and LOCUS criteria.
Experience using EMR software required.
Kipu experience required.

Responsibilities

Advocate on behalf of assigned facilities with insurance carriers.
Communicate effectively with clinical teams to understand patient treatment needs.
Work collaboratively with insurance providers, care managers, clinicians, admissions teams, and facility staff.
Track authorization start and end dates to help prevent lapses in coverage.
Document payer interactions, reference numbers, authorization outcomes, and determinations clearly and accurately.
Provide detailed feedback and clinical quality management support to assigned facilities.
Coordinate with clinical staff and admissions teams to ensure payer needs are met quickly.
Follow established utilization review workflows and participate in ongoing training and coaching.
Manage a caseload of approximately 30–50 patients.
Maintain professional verbal and written communication internally and externally.
Stay focused, organized, and detail-oriented throughout the day.
Support continuous improvement through accuracy, consistency, and reliable execution.
Multitask effectively while working as part of a team.
Handle reviews after standard business hours as needed.