Utilization Review Specialist — SUD Insurance Authorizations

Discovery Institute Drug & Alcohol Rehab New Jersey; Marlboro Township (NJ); On-site; USD 55,000 - 75,000; Full time

Job summary

The Utilization Review (UR) Specialist at Discovery Institute Drug & Alcohol Rehab New Jersey will obtain initial and concurrent insurance authorizations for all levels of care, review clinical documentation for medical necessity, and submit materials to payers to maximize reimbursement.

You will work closely with Admissions, Clinical, Nursing, and Billing teams to ensure timely authorizations, monitor expirations, and handle appeals when needed, while maintaining HIPAA and Joint Commission

Qualifications

• High school diploma required; Associate's or Bachelor's degree preferred.
• Minimum of two years in utilization review, case management, medical billing, or behavioral healthcare.
• Experience in substance use disorder or behavioral health treatment strongly preferred.
• Knowledge of ASAM Criteria preferred.
• Knowledge of Medicaid, commercial insurance, and managed care plans.
• Strong organizational and time management skills.
• Proficient in Microsoft Office and EHR systems.

Responsibilities

• Obtain initial and concurrent insurance authorizations for all levels of care.
• Review clinical documentation to ensure medical necessity.
• Submit clinical information to insurance companies within required timeframes.
• Monitor authorization expiration dates and request extensions.
• Communicate authorization decisions and payer requirements to clinical staff.
• Track approved days and notify leadership of denials or reductions in care.
• Prepare and submit appeals for denied services when appropriate.
• Maintain accurate authorization records in the electronic health record (EHR).
• Work collaboratively with Admissions, Clinical, Nursing, and Billing departments.
• Verify insurance benefits and coverage when necessary.
• Monitor payer portals for authorization updates.
• Assist with Medicaid and managed care authorization processes.
• Participate in utilization review meetings and case conferences.
• Generate reports on authorization status, denials, appeals, and payer trends.
• Ensure compliance with Joint Commission, state, federal, and payer regulations.
• Maintain confidentiality in accordance with HIPAA regulations.

Skills

Communication skills

Organizational skills

Time management

Attention to detail

Customer service

Independent work

Team collaboration

Education

High school diploma

Associate's or Bachelor's degree preferred

Tools

Microsoft Office

Electronic Health Records (EHR) systems

Job description

The Utilization Review (UR) Specialist at Discovery Institute Drug & Alcohol Rehab New Jersey will obtain initial and concurrent insurance authorizations for all levels of care, review clinical documentation for medical necessity, and submit materials to payers to maximize reimbursement.

You will work closely with Admissions, Clinical, Nursing, and Billing teams to ensure timely authorizations, monitor expirations, and handle appeals when needed, while maintaining HIPAA and Joint Commission