Utilization Review Specialist: SUD Care Access & Compliance

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

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.