Utilization Review Specialist - Behavioral Health Liaison

CareRite Centers, LLC; Englewood Cliffs, Englewood (NJ, NJ); On-site; USD 65,000 - 95,000; Full time

Job summary

Advanced Revenue Solutions is seeking an UR Specialist to oversee utilization review and insurance authorizations for SUD treatment at Britelife Recovery. You will coordinate with clinical staff, admissions, and payers to ensure timely authorizations and appropriate levels of care.

Ideal candidates have 2–3 years of UR or case management experience in behavioral health, knowledge of ASAM criteria, and strong documentation skills. Proficiency with EHRs, insurer portals, and MS Office is required.

Qualifications

• 2–3 years of UR, case management, or insurance coordination in behavioral health.
• Knowledge of ASAM criteria and levels of care.
• Experience with managed care, authorizations, and payer requirements.
• Bachelor's degree in Nursing, Social Work, Psychology, or related field; advanced degree or licensure preferred.
• Strong organizational, communication, and time management skills.
• Proficiency with EHRs, insurance portals, and Microsoft Office.
• Experience with Collaborative MD and KIPU is a plus.
• Experience in detox and residential SUD programs.
• Knowledge of major insurer platforms (Optum, Aetna, BCBS, Cigna).
• Ability to advocate for clients while balancing payer relationships and compliance.

Responsibilities

• Oversee and coordinate utilization review and insurance authorization for SUD treatment.
• Obtain prior authorizations and continued stay approvals from payers.
• Communicate clinical necessity based on ASAM criteria and DSM-5.
• Track and document all insurance communications in the EHR and UR logs.
• Collaborate with clinicians, admissions, medical staff, and payers.
• Ensure treatment plans and progress notes reflect medical necessity.
• Participate in multidisciplinary team meetings.
• Assist staff with proper documentation practices for insurance justification.
• Maintain payer policy compliance, HIPAA, and utilization protocols.
• Monitor denials and length-of-stay trends for performance improvement.
• Assist in appeals and peer reviews with required documentation.
• Provide training on documentation best practices.
• Engage in special projects as assigned.

Skills

Clinical judgment

Documentation skills

ASAM criteria

Communication

Time management

Advocacy for clients

Payer communication

Clinical writing

Detox & residential SUD experience

Independent problem solving

Stamina for stairs and lifting 25 lbs

Education

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

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

Tools

EHRs

Insurance portals

Microsoft Office

Job description

Advanced Revenue Solutions is seeking an UR Specialist to oversee utilization review and insurance authorizations for SUD treatment at Britelife Recovery. You will coordinate with clinical staff, admissions, and payers to ensure timely authorizations and appropriate levels of care.

Ideal candidates have 2–3 years of UR or case management experience in behavioral health, knowledge of ASAM criteria, and strong documentation skills. Proficiency with EHRs, insurer portals, and MS Office is required.