Utilization Review Specialist

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The Utilization Review Specialist is responsible for managing all aspects of the utilization review process, including preauthorization, Single Case Agreements (SCA), continued authorizations, and collaboration with clinical staff to ensure documentation meets insurance requirements. This role is crucial in securing necessary authorizations for various levels of care, advocating for clients with insurance providers, and supporting the clinical team through training on medical necessity and documentation best practices. Work with outside agencies and third-party contractors as indicated or needed.

Preauthorization

• Manage and submit preauthorization requests to insurance providers for clients entering treatment at Residential, Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP), and Standard Outpatient (OP) levels of care.
• Ensure all required documentation is complete and acc...