UTILIZATION REV SPEC I

Aspire Health Partners, Inc.; Orlando (FL); On-site; USD 52,000 - 68,000; Full time

Job summary

Aspire Health Partners in Orlando, FL is seeking a Utilization Review Specialist to coordinate insurance utilization review for hospitalized clients, support treatment planning, and ensure timely authorizations.

You will work with clinical teams, insurance reviewers, and internal departments to optimize patient outcomes while maintaining confidentiality and compliance with organizational policies.

Qualifications

• High School Diploma or equivalent
• Level II Background clearance- All Aspire Health Partners Internships and Careers require Level 2 clearance, with Aspire covering fingerprinting costs.
• Valid driver’s license with an acceptable driving record per organizational guidelines

Responsibilities

• Partner daily with the Access Center and/or Crisis Response Center (CRC) to identify clients needing utilization review
• Communicate clinical information to insurance reviewers to secure authorizations and extended lengths of stay
• Collaborate with attending psychiatrists on clinical assessments and treatment recommendations
• Participate in interdisciplinary treatment team meetings to support care for managed care clients
• Provide constructive clinical feedback to enhance service delivery and patient care
• Ensure accurate authorization details are submitted to Patient Accounts for billing
• Review client charts for potential denial issues and support appeal processes when needed
• Maintain strict adherence to ethical standards, confidentiality, and organizational policies

Job description

UTILIZATION REV SPEC I

Aspire Health Partners ORLANDO, Florida, United States

About this position

Make a Difference in Behavioral Health Care

At Aspire Health Partners, we are dedicated to transforming lives through compassionate, high-quality behavioral healthcare. As Florida’s largest nonprofit behavioral health provider, we serve diverse populations across Central Florida and are committed to clinical excellence and meaningful impact.

We are currently seeking a Utilization Review Specialist to join our team and play a key role in ensuring our clients receive the care they need while supporting effective coordination with insurance providers.

Position Summary

In this role, you will coordinate and manage insurance utilization review activities for hospitalized clients. You’ll work closely with clinical teams, insurance representatives, and internal departments to ensure timely authorizations, support treatment planning, and contribute to high-quality patient outcomes.

Key Responsibilities

• Partner daily with the Access Center and/or Crisis Response Center (CRC) to identify clients needing utilization review
• Communicate clinical information to insurance reviewers to secure authorizations and extended lengths of stay
• Collaborate with attending psychiatrists on clinical assessments and treatment recommendations
• Participate in interdisciplinary treatment team meetings to support care for managed care clients
• Provide constructive clinical feedback to enhance service delivery and patient care
• Ensure accurate authorization details are submitted to Patient Accounts for billing
• Review client charts for potential denial issues and support appeal processes when needed
• Maintain strict adherence to ethical standards, confidentiality, and organizational policies

Qualifications

Required:

• High School Diploma or equivalent
• Level II Background clearance- All Aspire Health Partners Internships and Careers require Level 2 clearance, with Aspire covering fingerprinting costs. Click https://info.flclearinghouse.c... to learn more.
• Valid driver’s license with an acceptable driving record per organizational guidelines

Preferred:

• Experience in behavioral health, utilization review, or managed care environments
• LPN or RN experience
• Strong communication, documentation, and organizational skills

Why Join Aspire?

• Mission-driven organization making a real impact in your community
• Collaborative, team-focused work environment
• Opportunities for growth and professional development
• A role where your work directly supports quality care and patient outcomes

Equal Opportunity Employer

Aspire Health Partners is a drug-free workplace and an Equal Opportunity Employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will be considered without regard to race, color, religion, national origin, sex, age, disability, or veteran status.