Utilization Review Specialist (Remote)

Utilization Review Specialist – Behavioral Health (Remote)

Location: Glendale, Arizona (Remote)

Employment Type: Full-Time

Work Environment: Behavioral Health Treatment Facility

Compensation: $70,000 – $90,000 annually (based on experience)

About the Role

We are seeking an experienced and detail-oriented Utilization Review Specialist to join our behavioral health team. This position plays a key role in managing authorizations, Single Case Agreements (SCAs), and continued stay reviews across multiple levels of care, including Residential, PHP, IOP, and Outpatient.

The ideal candidate has hands-on experience with commercial payers, understands medical necessity criteria, and can confidently navigate insurance processes to secure timely approvals for treatment.

This is a remote position supporting a compassionate, mission-driven team dedicated to improving the lives of adolescents and teens through evidence-based mental health and addiction treatment.

Why Join Our Team

• Make a Difference: Work with a team passionate about empowering youth and supporting families through recovery.
• Flexible Work Model: Remote position with strong virtual support and collaboration.
• Outstanding Benefits:
• Medical, Dental, and Vision Insurance
• Paid Time Off (PTO) & Sick Leave
• 401(k) with Matching
• Tuition Reimbursement
• Gym and Yoga Membership Reimbursement
• Life Insurance & HSA Options
• Professional Development Assistance

Key Responsibilities

Authorization Management

• Submit preauthorization and continued authorization requests for all levels of care (Residential, PHP, IOP, and OP).
• Review clinical documentation to ensure medical necessity is met and accurately represented.
• Communicate directly with insurance payers to obtain and extend coverage approvals.

Single Case Agreements (SCAs)

• Negotiate and manage SCAs for out-of-network services.
• Document and communicate SCA approvals to billing and clinical teams.

Collaboration with Clinical Teams

• Partner with clinicians to ensure treatment plans align with payer requirements.
• Attend regular team meetings to review client progress and discuss authorization strategies.
• Provide education on documentation standards and payer expectations.

Client Advocacy

• Serve as a liaison between clients, clinicians, and insurance payers.
• Appeal denials as needed, supplying supporting documentation to overturn decisions.

Compliance & Reporting

• Maintain detailed, compliant records of all utilization review activities.
• Generate reports on authorization outcomes and identify opportunities for process improvement.

Qualifications & Requirements

Experience:

• 3–5 years of experience in utilization review, medical billing, or related field (behavioral health preferred).
• Strong background working with commercial payers and medical necessity criteria.
• Proven success managing Single Case Agreements (SCAs) and continued stay authorizations.

Education:

• Bachelor’s degree in Healthcare Administration, Social Work, Nursing, or related field preferred.

Skills:

• Expertise in payer communication, documentation review, and authorization workflows.
• Exceptional communication, organization, and negotiation skills.
• Ability to manage multiple priorities and meet strict deadlines.

Ideal Candidate Attributes

• Experienced in behavioral health utilization review and familiar with payer standards.
• Confident in advocating for client care and securing authorizations.
• Meticulous with documentation and compliance requirements.
• Collaborative, solutions-focused, and adaptable to a remote environment.

How to Apply

If you’re a skilled Utilization Review professional passionate about ensuring clients receive the care they need, we’d love to hear from you.

Please submit your current resume or CV for confidential consideration. Cover letters and references are welcome but not required.

Join a compassionate behavioral health team dedicated to improving lives and advancing recovery—apply today.

3-5 years of experience in utilization review, medical billing, or a related field, preferably in a behavioral health setting.

Established relationships and communication skills with commercial insurance payers

Proven experience managing and negotiating Single Case Agreements (SCAs).

Expertise in continued authorization processes for Residential, PHP, and IOP levels of care.