Utilization Review Specialist: Optimize Care & Approvals

Summit BHC Mesa, LLC; United States; On-site; USD 49,000 - 60,000; Full time

Job summary

Canyon Vista Recovery Center seeks a Full Time Utilization Review Specialist in Mesa, Arizona. You will review admissions, stays, and discharge planning using approved criteria to obtain authorizations and support utilization management.

The role requires collaboration with physicians and insurers, accurate documentation, and timely reporting to drive coverage decisions and care coordination. A licensed nurse or equivalent is preferred, with UR experience valued.

Qualifications

• High School diploma or equivalent required.
• Graduation from an approved/accredited nursing school or related health field preferred.
• ASAM or UR experience preferred; substance abuse setting experience valued.

Responsibilities

• Performs admission, concurrent, continued stay, and retrospective reviews using hospital criteria.
• Communicates with insurers for authorization of days and treatment.
• Maintains accurate documentation and coordinates with physicians and staff on charting and medical necessity.
• Assists with pre-certifications, benefit verification, and discharge planning as required.
• Coordinates information with the business office to resolve payment issues.

Skills

Communication skills

Collaboration

Documentation

Education

High school diploma or equivalent

RN/LPN or related clinical license

BS in social work or related health field (preferred)

Job description

Canyon Vista Recovery Center seeks a Full Time Utilization Review Specialist in Mesa, Arizona. You will review admissions, stays, and discharge planning using approved criteria to obtain authorizations and support utilization management.

The role requires collaboration with physicians and insurers, accurate documentation, and timely reporting to drive coverage decisions and care coordination. A licensed nurse or equivalent is preferred, with UR experience valued.