Utilization Review (UR) Specialist

Are you experienced in psychiatric care and passionate about ensuring patients receive the right level of care at the right time? We are seeking a dedicated Utilization Review (UR) Specialist to join our team and support our mission of delivering quality behavioral health services.

What You’ll Do

• Conduct utilization reviews to determine medical necessity and appropriate levels of care for psychiatric and behavioral health patients.

• Collaborate with physicians, nurses, and treatment teams to develop individualized care plans that align with payer requirements.

• Communicate with insurance companies, providing clinical documentation and justifications to support ongoing care.

• Monitor patient progress and identify opportunities for earlier discharge or transitions to alternative levels of care.

• Maintain accurate and timely documentation in compliance with state, federal, and organizational standards.

• Serve as a resource for clinical teams regarding payer guidelines, authorizations, and managed care processes.

What You’ll Bring

• Required: Experience working in psychiatric, behavioral health, or mental health settings.

• Strong knowledge of managed care, payer guidelines, and utilization management processes.

• Excellent clinical assessment, critical thinking, and communication skills.

• Ability to collaborate across interdisciplinary teams and interact with external stakeholders.

• Nursing license (RN, LPN) preferred, but candidates with strong behavioral health utilization review experience will also be considered.

Why Join Us?

• Be part of a mission-driven organization focused on patient-centered care.

• Work alongside a supportive and collaborative clinical team.

• Competitive pay and comprehensive benefits package.

• Opportunities for growth in a growing behavioral health network.