UR Specialist

New Vista Behavioral Health; Cleveland (OH); On-site; USD 41,000 - 47,000; Full time

Benefits offered by this job

Medical plans

PTO & holidays

401(k) with company contribution

Tuition reimbursement

Job summary

New Vista Behavioral Health is seeking a detail-oriented Utilization Review Specialist with clinical background to support utilization review and insurance authorizations across multiple behavioral health facilities. The role requires active RN, LCSW, or LPC licensure and experience in medical necessity review.

You will coordinate authorizations, review documentation, monitor payer requirements, and collaborate with UR teams, admissions, billing, and insurance companies to promote appropriate

Qualifications

• Active clinical license required (RN, LCSW, LPC) and behavioral health experience.
• Experience with utilization review, insurance authorizations, or managed care.
• Knowledge of medical necessity criteria and payer requirements.
• Strong clinical assessment and documentation review skills.
• Excellent written and verbal communication with payers and clinical teams.
• Ability to manage multiple facilities and deadlines.
• Proficiency with electronic health records and healthcare documentation systems.

Responsibilities

• Coordinate and monitor insurance authorizations and utilization reviews across multiple behavioral health facilities.
• Conduct and coordinate initial, concurrent, and continued-stay reviews with insurance companies and managed care plans.
• Review clinical documentation to determine medical necessity and level of care.
• Track authorization dates, approved treatment days, and payer requirements.
• Communicate with payers and utilization management representatives regarding authorizations.
• Collaborate with UR teams, clinical staff, admissions, and billing to resolve issues.
• Identify denials, reduced authorizations, and barriers to reimbursement.
• Assist with denials management, appeals, and peer-to-peer review coordination.
• Provide guidance on payer requirements and documentation for utilization review.
• Maintain accurate authorization records in EHR and tracking systems.
• Monitor UR trends and assist with reporting, audits, and process improvements.
• Support compliance with HIPAA and regulatory standards.

Skills

Behavioral health knowledge

Utilization review

Insurance authorizations

Clinical assessment

HIPAA/compliance

Written and verbal communication

Education

RN license

LCSW license

LPC license

Tools

Electronic Health Records

Microsoft Office

Job description

Job Type: Full-time
Pay Range: $30 - $34hr
Location: 14055 Cedar Rd.Ste. 200, Cleveland, OH 44118

Job Summary

New Vista Behavioral Health is seeking a detail-oriented and clinically experienced Utilization Review Specialist to support utilization review and insurance authorization processes across multiple behavioral health facilities.

Candidates must hold an active clinical license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), LSW / LCSW

The Utilization Review Specialist will coordinate insurance authorizations, review clinical documentation for medical necessity, monitor payer requirements, and support timely reimbursement for behavioral health and substance use disorder treatment services. This position will collaborate with facility-based utilization review teams, clinical leadership, admissions, billing, and insurance companies to promote appropriate levels of care, prevent avoidable denials, and maintain compliance with payer requirements.

The ideal candidate has a clinical background, strong knowledge of behavioral health treatment, and experience with utilization review, insurance authorizations, or managed care.

Essential Duties and Responsibilities

• Coordinate and monitor insurance authorizations and utilization reviews across multiple behavioral health facilities.
• Conduct and coordinate initial, concurrent, and continued-stay reviews with commercial insurance companies, managed care organizations, and government-funded health plans, as applicable.
• Review clinical documentation to determine whether it supports medical necessity and continued treatment at the requested level of care.
• Track authorization dates, approved treatment days, review deadlines, and payer-specific requirements.
• Communicate with insurance companies, utilization management representatives, and clinical reviewers regarding authorizations and additional documentation requests.
• Collaborate with facility UR teams, clinical staff, admissions, and billing to resolve authorization issues and prevent gaps in coverage.
• Identify and elevate potential denials, reduced authorizations, expired approvals, and other barriers to reimbursement.
• Assist with denial management, appeals, reconsiderations, and peer-to-peer review coordination.
• Provide clinical and operational guidance to facility teams regarding payer requirements, medical necessity documentation, and utilization review processes.
• Maintain accurate authorization records, review outcomes, and payer communications in electronic health records and tracking systems.
• Monitor utilization review trends and assist with reporting, audits, and process improvement initiatives.
• Support compliance with organizational policies, HIPAA, payer requirements, and applicable regulatory standards.
• Perform other related duties as assigned.

Required Qualifications

• Acceptable clinical licenses may include RN, LCSW, LPC
• Experience in behavioral health, substance use disorder treatment, utilization review, utilization management, or a related healthcare setting.
• Knowledge of medical necessity criteria, insurance authorization procedures, and concurrent review processes.
• Strong clinical assessment, documentation review, and critical-thinking skills.
• Excellent written and verbal communication skills, including the ability to communicate effectively with insurance payers and multidisciplinary clinical teams.
• Strong organizational skills and the ability to manage multiple priorities, facilities, and deadlines.
• Proficiency with electronic health records, Microsoft Office, and healthcare documentation systems.
• Ability to maintain patient confidentiality and comply with HIPAA requirements.

Preferred Qualifications

• Previous experience in behavioral health utilization review or insurance authorization.
• Experience supporting multiple facilities in a corporate or centralized utilization review department.
• Experience with inpatient psychiatric, residential treatment, partial hospitalization (PHP), intensive outpatient (IOP), or substance use disorder programs.
• Experience with insurance denials, appeals, peer-to-peer reviews, and managed care organizations.
• Experience monitoring utilization review performance metrics and supporting process improvement initiatives.

Why You’ll Love It Here (Full-Time Benefits)

• Multiple medical plan options, Vista Wellness (physician/pharmacy), Dental, Vision
• Generous PTO and paid holidays
• 401(k) with company contribution; Life and disability coverage
• Tuition reimbursement up to $15,000 and student loan assistance programs