Utilization Review Specialist (in-office only)Quadrant Health Group • Dania Beach, FL, United States
[error_messages.no_longer_accepting]
Utilization Review Specialist (in-office only)
Quadrant Health Group • Dania Beach, FL, United States
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]Serve as a strong patient advocate, effectively communicating clinical justifications to insurance payers. Apply medical necessity criteria to secure initial and continued authorizations across all levels of care. Utilize problem-solving and critical thinking to navigate complex authorization issues and minimize denials. Work closely with clinical teams to ensure treatment plans align with insurance criteria for continued authorization. Provide ongoing feedback to facilities regarding documentation improvements, level of care justifications, and payer trends. Serve as the primary point of contact between facilities and the billing team, ensuring smooth coordination and timely approvals. Proactively educate and guide facilities on insurance requirements, helping them adapt to payer expectations. Maintain clear, professional, and proactive communication with facility staff, insurance representatives, and internal billing teams. Manage a caseload of 50-70 patients, ensuring timely follow-ups, thorough documentation, and strong attention to detail. Document all interactions in the EMR (Kipu experience required) and ensure all authorization trackers are up to date. Ensure that denied or pended cases are escalated appropriately through peer reviews or appeals. Efficiently navigate EMR systems (Kipu experience required) Utilize Google Docs, Google Sheets, and Google Drive for internal reporting, tracking, and collaboration. Assist in after-hours utilization reviews as needed to prevent service disruptions and maintain compliance. Adapt quickly to payer policy changes and ensure facilities are informed of updates that impact clinical documentation and authorization processes. Minimum of 3 years of clinical experience in behavioral health, with a solid grasp of medical necessity criteria and levels of care. Prior experience in utilization review, case management, or insurance authorization within the behavioral healthcare space. Strong analytical and problem-solving abilities, with the capacity to think strategically and advocate effectively for treatment approvals. Excellent written and verbal communication skills, with the ability to collaborate across internal teams and external stakeholders. Highly organized and detail-oriented, capable of managing a high-volume caseload in a fast-paced environment. Proficiency in Kipu EMR and Google Workspace tools (Drive, Sheets, Docs) is required. Customer-focused mindset with the ability to build and maintain strong relationships with partner facilities and serve as a reliable, knowledgeable resource. A clear understanding that utilization review is not solely about approvals, it's about upholding clinical integrity, ensuring compliance, and supporting the intersection of quality care and financial sustainability.
Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions, a proud member of the Quadrant Health Group, i s seeking a passionate and dedicated Utilization Review Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively.
Why Join Quadrant Health Group?
- Competitive salary commensurate with experience.
- Comprehensive benefits package, including medical, dental, and vision insurance.
- Paid time off, sick time and holidays.
- Opportunities for professional development and growth.
- A supportive and collaborative work environment.
- A chance to make a meaningful impact on the lives of our clients.
Compensation : $60,000 - $75,000 a year - (Based on experience) Full-time
What You'll Do :
The UR Specialist plays a critical role in ensuring both clinical quality management and financial viability for our partner facilities. This position is not just about securing authorizationsits about bridging the gap between clinical care and revenue cycle management. UR Specialists serve as the direct liaison between facility clinical teams, insurance providers, and the billing department, ensuring seamless communication, accurate documentation, and optimal patient outcomes.
This is an in-office position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be considered.
Key Responsibilities
Clinical Advocacy
Facility Collaboration & Clinical Quality Management
Communication & Case Management
Operational Excellence & Technology Utilization
What Were Looking For
About Quadrant Billing Solutions :
At Quadrant Billing solutions, we believe in fostering a culture of compassion, innovation, and excellence. We are dedicated to empowering individuals to achieve their optimal health and well-being. Our team is comprised of highly skilled professionals who are passionate about making a difference in the lives of those we serve. Join us and be part of a team that values your contributions and supports your professional growth.
#HP
Compensation details : 60000-75000 Yearly Salary
PI13b10b2b4871-26289-38876737
[job_alerts.create_a_job]
Utilization Review Specialist • Dania Beach, FL, United States
[internal_linking.related_jobs]
Collections Specialist—Behavioral Health – Exact Billing Solutions (EBS) .Eligible for performance Bonus • •.Exact Billing Solutions is a unique team of revenue cycle management profes...[show_more]
TravelNurseSource is working with Lancesoft Inc to find a qualified OR RN in Fort Lauderdale, Florida, 33331!.Cleveland Clinic Weston Hospital - Nursing.
Candidates must have experience.Established ...[show_more]
Perform all functions required to prepare the appropriate commercial loan documents in accordance with Bank policies, procedures and regulatory compliance based on borrowing entity, purpose of proc...[show_more]
Join Our Part-Time Research Studies Today!.Are you eager to earn extra income from the comfort of your home? We are looking for motivated individuals to participate in paid research studies includi...[show_more]
Revenue Cycle Specialist—Behavioral Health – Exact Billing Solutions (EBS) .Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use diso...[show_more]
Earn up to $16 USD / hourly and work remotely and flexibly.Outlier, a platform owned and operated by Scale AI, is looking for.
If you're passionate about improving models and excited by the future of ...[show_more]
At EisnerAmper, we look for individuals who welcome new ideas, encourage innovation, and are eager to make an impact.Whether you're starting out in your career or taking your next step as a seasone...[show_more] Join Our Part-Time Research Studies Today!.Are you eager to earn extra income from the comfort of your home? We are looking for motivated individuals to participate in paid research studies includi...[show_more] 
We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up...[show_more]
AlliedTravelCareers is working with Triage Staffing LLC to find a qualified Sterile Processing Tech in Fort Lauderdale, Florida, 33301!.
Travel Nursing : Sterile Processing Fort Lauderdale.Location : ...[show_more] Earn up to $16 USD / hourly and work remotely and flexibly.Outlier, a platform owned and operated by Scale AI, is looking for.
If you're passionate about improving models and excited by the future of ...[show_more] 
You'll work directly with Americas self-employed, small business owners and individuals to help them access a product suite of affordable benefits and business services.
Our clients are looking for ...[show_more]
Our private dental office is seeking an Office Manager to join our dedicated team of dental professionals in the Fort Lauderdale FL area.
We strive to give our patients an outstanding experience fro...[show_more] Earn up to $16 USD / hourly and work remotely and flexibly.Outlier, a platform owned and operated by Scale AI, is looking for.
If you're passionate about improving models and excited by the future of ...[show_more] 
Role Overview • • We’re seeking experienced • •Utility Management Nurses • • to support a client’s healthcare product development by leveraging expertise in • •insurance coding and hospital revenue manag...[show_more] Join Our Part-Time Research Studies Today!.Are you eager to earn extra income from the comfort of your home? We are looking for motivated individuals to participate in paid research studies includi...[show_more] 
This is a position within Keller Executive Search and not with one of its clients.Ready to supercharge executive searches at a global firm impacting top talent worldwide? Join Keller Executive Sear...[show_more] AlliedTravelCareers is working with Aya Healthcare to find a qualified Sterile Processing Tech in Fort Lauderdale, Florida, 33301!.
Aya Healthcare has an immediate opening for the following position...[show_more]
Collections Specialist
ICBD • Hollywood, FL, US
[job_card.full_time]
[filters_job_card.quick_apply]
[last_updated.last_updated_variable_days]
Travel Nurse RN - Operating Room - $2,550 to $2,600 per week in Fort Lauderdale, FL
TravelNurseSource • Fort Lauderdale, FL, US
[job_card.full_time] +1
[last_updated.last_updated_1_day] • [promoted]
Senior Document Services Specialist
Seacoast National Bank • Fort Lauderdale, FL, United States
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Remote Study Participant (Flexible Earnings Up to $3,000) (Hiring Immediately)
Maxion Research • Isle of Normandy, Florida, US
[filters.remote]
[job_card.part_time]
[last_updated.last_updated_30] • [promoted]
Revenue Cycle Specialist
ICBD • Hollywood, FL, United States
[job_card.full_time]
[last_updated.last_updated_1_hour] • [promoted] • [new]
Remote AI Content Reviewer
Outlier • Fort Lauderdale, FL, United States
[filters.remote]
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Manager - Outsourced Accounting Services (Special Projects)
EisnerAmper • Fort Lauderdale, FL, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Remote Feedback Specialist - High Income Potential (Hiring Immediately)
Maxion Research • Dania Beach, Florida, US
[filters.remote]
[job_card.part_time]
[last_updated.last_updated_30] • [promoted]
Flexible Remote Opinion Contributor (Hiring Immediately)
Earn Haus • North Miami Beach, Florida, US
[filters.remote]
[job_card.full_time] +1
[last_updated.last_updated_30] • [promoted]
Travel Sterile Processing Tech - $1,051 per week in Fort Lauderdale, FL
AlliedTravelCareers • Fort Lauderdale, FL, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Remote Content QA Reviewer
Outlier • Hollywood, FL, United States
[filters.remote]
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Open Enrollment Specialist
USHEALTH • Fort Lauderdale, FL, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Office Manager
Dental Office • Fort Lauderdale, Florida, USA
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
AI Writing Reviewer - Remote
Outlier • Hollywood, FL, United States
[filters.remote]
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Remote Utility Management Nurses (Insurance Coding & Revenue Management) - AI Trainer ($45-$75 per hour)
Mercor • Hollywood, Florida, US
[filters.remote]
[job_card.part_time]
[last_updated.last_updated_variable_days] • [promoted]
Earn up to $3,000 Participating in Medical Surveys! - Ultimate Work-from-Home Flexibility (Hiring Immediately)
Maxion Research • Dania Beach, Florida, US
[filters.remote]
[job_card.part_time]
[last_updated.last_updated_30] • [promoted]
Office Administration Specialist
Keller Executive Search • Fort Lauderdale, FL, US
[filters.remote]
[job_card.full_time]
[filters_job_card.quick_apply]
[last_updated.last_updated_variable_days]
Travel Sterile Processing Tech - $914 to $1,144 per week in Fort Lauderdale, FL
AlliedTravelCareers • Fort Lauderdale, FL, US
[job_card.full_time] +1
[last_updated.last_updated_30] • [promoted]