Utilization Review Specialist (Remote)

The Florida House; Oregon; Hybrid; USD 55,000 - 96,000; Part time

Benefits offered by this job

Medical, Dental, and Vision Insurance

401(k) Retirement Plan

Generous PTO & Vacation Time

Employee Assistance Program

Opportunities for Professional Growth

Free CEU's

Free CPR Certification

Free CPI Certification

Job summary

FHE Health in the United States is seeking an experienced Utilization Review (UR) Specialist to manage clinical authorization processes, ensuring timely and accurate communication with insurance payers and adherence to payer guidelines. This role supports patient access to behavioral health treatment by securing initial and continued-stay authorizations while preventing denials.

This per diem, as-needed position focuses on maximizing reimbursement, maintaining compliance, and collaborating with

Qualifications

• Bachelor's degree in Nursing, Social Work, Behavioral Health or related field.
• 2-3 years of utilization review experience in behavioral health, addiction treatment, or managed care.
• Strong understanding of ASAM criteria, LOCUS, DSM-5, diagnostic standards, and documentation requirements.
• Excellent clinical summarization and documentation review skills.
• Strong communication with clinical teams and insurance reviewers.
• Ability to problem-solve, escalate appropriately, and manage time-sensitive deadlines.
• High attention to detailed accuracy.

Responsibilities

• Responsible for managing all clinical authorization processes to ensure timely, accurate, and compliant communication with insurance payers.
• Supports patient access to treatment by securing initial and continued-stay authorizations, preventing avoidable denials, and collaborating with clinical teams to ensure documentation reflects medical necessity according to payer guidelines.
• The UR Specialist helps maximize reimbursement, maintain compliance, and support quality patient care throughout the behavioral health and addiction treatment continuum.

Skills

Utilization review experience

ASAM criteria knowledge

LOCUS

DSM-5 knowledge

Documentation review

Clinical summarization

Communication with clinical teams

Time management

Attention to detail

Education

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

Job description

About Us

About UsFHE Health ("FHE") is a nationally recognized behavioral healthcare institution that delivers quality, medically integrated personalized treatment for those suffering from Behavioral Health Disorders. We specialize in addictive disorders and other behavioral health diagnoses such as mood disorders, depression, anxiety, and traumatic disorders. We employ a team of highly qualified, compassionate individuals who share in the desire to serve this vulnerable population. We provide innovative treatment by creating an environment that promotes healing and optimized learning.FHE Health is a facility licensed by both the Department of Children and Families (DCF) and the Agency for Healthcare Administration (AHCA). We are accredited by both the JOINT Commission and the Commission of Accreditation of Rehabilitation Facilities (CARF)We are members of the National Association of Addiction Treatment Providers (NAATP), and Deerfield Beach's Best Alcohol and Drug Rehabilitation Center. We are not conventional; we are at the forefront of a medically integrated, modern, scientific, and technological approach to behavioral health and addiction treatment, delivering progressive services not seen in the behavioral health market.As an eight-time "Top Workplace" award winner, we take pride in offering an innovative and collaborative work culture where compassion meets excellence.

Who We're Looking For

We are seeking an experienced specialist who is passionate about making a difference in the lives of individuals battling behavioral health and substance use disorder challenges.

What You'll Do

• Responsible for managing all clinical authorization processes to ensure timely, accurate, and compliant communication with insurance payers.
• This role supports patient access to treatment by securing initial and continued-stay authorizations, preventing avoidable denials, and collaborating with clinical teams to ensure documentation reflects medical necessity according to payer guidelines.
• The UR Specialist helps maximize reimbursement, maintain compliance, and support quality patient care throughout the behavioral health and addiction treatment continuum.

What You Need

• Bachelor's Degree from accredited college or university in Nursing, Social Work, Behavioral Health or related field required preferred.
• 2-3 years of utilization review experience in behavioral health, addiction treatment, or managed care.
• Strong understanding of ASAM criteria, LOCUS, DSM-5, diagnostic standards, and documentation requirements.
• Excellent clinical summarization and documentation review skills.
• Strong communication with clinical teams and insurance reviewers.
• Ability to problem-solve, elevate appropriately, and manage time-sensitive deadlines.
• High attention to detailed accuracy

Why Join FHE Health?

As a full-time employee you'll be offered a comprehensive benefits package, including:

• Medical, Dental, and Vision Insurance
• Supplemental Life & Disability Insurance
• 401(k) Retirement Plan
• Generous PTO & Vacation Time
• Employee Assistance Program
• Opportunities for Professional Growth & Development
• Free CEU's
• Free CPR Certification
• Free Crisis Prevention Certification (CPI)

Take the Next Step in Your Career!

This is a per diem, as-needed position with no guaranteed hours