Utilization Review

Job description

Description The Utilization Review (UR) Specialist is responsible for managing the authorization process between HCANA facilities and third-party payers. This role ensures that all services provided—from detox to residential and intensive outpatient care—meet the criteria for medical necessity. The UR Specialist acts as a clinical advocate, utilizing clinical documentation to secure initial, concurrent, and retrospective authorizations, thereby ensuring the financial viability of the treatment provided and the continuity of care for our clients. Requirements: This job may require some after-hours work, as well as some hours on the weekend. For this reason, office hours may be flexible, with the option to work remotely, upon completion of training. Prior Utilization Review or Billing experience in a substance use treatment or medical setting is a plus. Prior experience with electronic medical records a plus, especially KIPU knowledge. Knowledge of ASAM criteria a plus. - Authorization Management: Obtain and manage initial and concurrent authorizations for all levels of care. Monitor authorization end-dates to ensure timely clinical reviews. - Clinical Advocacy: Conduct Live Reviews...