Utilization Review Specialist

BriteLife Recovery; Englewood (NJ); On-site; USD 65,000 - 90,000; Full time

Job summary

Advanced Revenue Solutions is seeking an Utilization Review (UR) Specialist to oversee insurance authorization for Britelife Recovery clients. You will coordinate reviews, gather clinical information, and ensure documentation aligns with medical necessity and payer requirements.

The role requires ASAM criteria expertise, strong written communication, and collaboration with clinical staff to maintain access to treatment while supporting organizational compliance.

Qualifications

• Knowledge of ASAM criteria and levels of care for SUD.
• Experience with managed care, insurance authorizations, and payer requirements.
• Bachelor's degree in Nursing, Social Work, Psychology, or related field; advanced licensure preferred.
• Excellent organizational, communication, and time management skills.
• Proficiency with EHRs, insurance portals, and Microsoft Office.

Responsibilities

• Coordinate initial and concurrent reviews for detox, residential, PHP, and IOP.
• Obtain prior authorizations and continued stay approvals from payers.
• Communicate clinical necessity using ASAM criteria and DSM-5.
• Document insurance communications and outcomes in the EHR and UR logs.
• Gather clinical information with clinicians and medical staff for reviews.
• Ensure treatment plans and progress notes reflect medical necessity.
• Participate in multidisciplinary team meetings to track progress.
• Assist staff with documentation practices for insurance justification.
• Maintain compliance with payer policies, HIPAA, and utilization protocols.
• Monitor denials and approvals to drive performance improvements.
• Assist in appeals and peer reviews with documentation.
• Provide training on documentation best practices for UR.
• Take on special projects as assigned.

Skills

ASAM criteria knowledge

Clinical writing

Communication skills

Time management

Advocacy

EHR proficiency

Education

Bachelor's degree in Nursing, Social Work, Psychology, or related field

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

Tools

EHRs

Insurance portals

Microsoft Office

Job description

What you will be doing?
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at Britelife Recovery. This role ensures timely approvals and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care.

The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial viability for the organization. Success in this role requires strong clinical judgment, documentation skills, familiarity with ASAM criteria, and a working knowledge of insurance guidelines specific to behavioral health

What tasks are required?

• Conduct initial and concurrent reviews for detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
• Obtain prior authorizations and continued stay approvals from commercial and other payers by submitting timely clinical reviews and documentation.
• Communicate clinical necessity of services based on ASAM criteria and DSM-5 diagnoses.
• Track and document all insurance-related communications, decisions, and outcomes in the EHR and UR logs.
• Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up-to-date clinical information for reviews.
• Ensure treatment plans, progress notes, and assessments are completed on time and accurately reflect medical necessity.
• Participate in multidisciplinary team meetings to stay informed on client progress and treatment goals.
• Assist staff with proper documentation practices to support insurance justification and compliance.
• Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols.
• Monitor trends in denials, approvals, and length-of-stay metrics to support organizational performance improvement.
• Assist in appeals and peer reviews by gathering required documentation and preparing clinical summaries.
• Provide training and support to staff on documentation best practices related to utilization review.
• Special projects as assigned

What we need from you?

• Minimum of 2–3 years of experience in utilization review, case management, or insurance coordination in a behavioral health or substance use treatment setting.
• Knowledge of ASAM criteria and levels of care for substance use and co-occurring disorders.
• Familiarity with managed care principles, insurance authorizations, and payer requirements.
• Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
• Excellent organizational, communication, and time management skills.
• Proficiency in Electronic Health Records (EHRs), insurance portals, and Microsoft Office tools.
• Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
• Experience or working knowledge with Collaborative MD and KIPU
• Experience in detox and residential SUD programs.
• Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna).
• Strong clinical writing skills and familiarity with medical necessity language.
• Ability to advocate for clients while balancing payer relationships and compliance.
• Ability to lift up to 25 pounds.
• Ability to walk up and down stairs during emergency drills or situations.

All ARS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. ARS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.