Utilization Review Specialist

Job Description

Job Description

Join KVC as a Utilization Review Specialist

Work Wellbeing Score : 82

Step into a role where your critical thinking, accuracy, and communication skills directly improve the care children, youth, and adults receive. At KVC, our Utilization Review Specialists are essential in ensuring timely, appropriate, and high-quality treatment. This is your opportunity to be part of meaningful work in a fast-paced, mission-driven environment.

Position Highlight : Hybrid Work Option

After completing the first 90 days in office and receiving a positive 90-day evaluation, the candidate may elect to transition to a hybrid work schedule consisting of 2 days in office and 3 days remote each week .

What You’ll Do

You will serve as the primary link between KVC’s treatment teams and health plans, ensuring accurate, timely communication regarding patient assessments, ongoing care, and discharge planning. Your work will influence treatment timelines, authorization success, care coordination, and overall patient experience.

This is a detail-heavy, high-impact position where your organization and communication skills shine.

What Makes This Role Stand Out

You collaborate daily with a multidisciplinary team of physicians, therapists, nurses, and admissions professionals.

You directly affect service approvals, care continuity, and patient outcomes.

You contribute to quality improvement initiatives that shape the future of KVC services.

You gain meaningful experience in a fast-paced department where precision truly matters.

Qualifications

Education

Bachelor’s degree in a human services field (social work, psychology, sociology, counseling, education, applied behavioral sciences) or criminal justice preferred

High school diploma or GED required

Experience

At least two years of experience in case management, utilization review, or wellness coordination

Minimum one year of experience working with economically disadvantaged, vulnerable, or at-risk youth and / or adults

Preferred Skills

Strong written and verbal communication

Intermediate proficiency in Microsoft Word, Excel, and Outlook

Highly organized and detail-oriented with the ability to work in a fast-paced environment

Certification / Licensure

Must be 21 or older

Valid driver’s license

Valid auto insurance

Key Responsibilities

Partner respectfully and inclusively with colleagues across all KVC departments

Build strong relationships with internal teams, external partners, referral sources, and insurance companies

Ensure all authorizations and child-specific contracts are entered correctly into electronic health records

Help maintain contractual relationships and collaborate with external agencies

Gather, compile, and enter data accurately into management systems

Conduct utilization reviews, submit required forms, communicate with insurance companies, and support appeals processes

Assist with intake assessments, discharge summaries, and documentation reviews

Maintain strict confidentiality and compliance with state, federal, and Joint Commission guidelines

Support admissions processes and various program needs

Participate in staff meetings, training, and special quality-improvement initiatives

If you’re looking for a role with impact, growth, and a team known for its strong wellbeing score, KVC welcomes you to apply. Together, we can make a lasting difference.