Utilization Review & Authorization Specialist

BriteLife Recovery; Englewood (NJ); On-site; USD 60,000 - 90,000; Full time

Job summary

Advanced Revenue Solutions is seeking an UR Specialist to oversee insurance authorizations and continued stay decisions for clients in substance use treatment at Britelife Recovery. You will coordinate initial and concurrent reviews, obtain prior authorizations, and advocate for appropriate levels of care based on ASAM criteria.

Working with clinical staff, admissions, and payers, you will document clinical necessity, monitor denials and approvals, and ensure HIPAA-compliant records.

Qualifications

• Must have 2–3 years in utilization review or case management in behavioral health.
• Knowledge of ASAM criteria and levels of care for SUDs is required.
• Familiarity with managed care, authorizations, and payer requirements.

Responsibilities

• Conduct initial and concurrent reviews for detox, residential, PHP, and IOP.
• Obtain prior authorizations and continued stay approvals from payers.
• Document clinical necessity based on ASAM criteria and diagnoses.
• Track communications and outcomes in the EHR and UR logs.
• Collaborate with clinicians and staff to gather up-to-date information.
• Ensure treatment plans and notes reflect medical necessity.
• Assist in appeals and peer reviews with clinical summaries.
• Maintain HIPAA compliance and payer policy alignment.
• Monitor denials and approvals to support performance improvement.

Skills

ASAM criteria knowledge

Utilization review

Insurance coordination

EHR proficiency

Clinical documentation

Education

Bachelor's degree in Nursing

Bachelor's degree in Social Work

Bachelor's degree in Psychology

Advanced degree or licensure (RN, LCSW, LPC, LMHC, or CADC)

Tools

Collaborative MD

KIPU

Optum

Aetna

BCBS

Cigna

Electronic Health Records

Job description

Advanced Revenue Solutions is seeking an UR Specialist to oversee insurance authorizations and continued stay decisions for clients in substance use treatment at Britelife Recovery. You will coordinate initial and concurrent reviews, obtain prior authorizations, and advocate for appropriate levels of care based on ASAM criteria.

Working with clinical staff, admissions, and payers, you will document clinical necessity, monitor denials and approvals, and ensure HIPAA-compliant records.