Urgent! Utilization Review Specialist Job Opening In Englewood – Now Hiring BriteLife Recovery
What you will be doing?
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at Britelife Recovery.
This role ensures timely approvals and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care.
The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial viability for the organization.
Success in this role requires strong clinical judgment, documentation skills, familiarity with ASAM criteria, and a working knowledge of insurance guidelines specific to behavioral health
What tasks are required?
+ Conduct initial and concurrent reviews for detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
+ Obtain prior authorizations and continued stay approvals from commercial and other payers by submitting timely clinical reviews and documentation.
+ Communicate clinical necessity of services based on ASAM criteria and DSM-5 diagnoses.
+ Track and document all insurance-related communications, decisions, and outcomes in the EHR and UR logs.
+ Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up-to-date clinical information for reviews.
+ Ensure treatment plans, progress notes, and assessments are completed on time and accurately reflect medical necessity.
+ Participate in multidisciplinary team meetings to stay informed on client progress and treatment goals.
+ Assist staff with proper documentation practices to support insurance justification and compliance.
+ Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols.
+ Monitor trends in denials, approvals, and length-of-stay metrics to support organizational performance improvement.
+ Assist in appeals and peer reviews by gathering required documentation and preparing clinical summaries.
+ Provide training and support to staff on documentation best practices related to utilization review.
+ Special projects as assigned
What we need from you?
+ Minimum of 2–3 years of experience in utilization review, case management, or insurance coordination in a behavioral health or substance use treatment setting.
+ Knowledge of ASAM criteria and levels of care for substance use and co-occurring disorders.
+ Familiarity with managed care principles, insurance authorizations, and payer requirements.
+ Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
+ Excellent organizational, communication, and time management skills.
+ Proficiency in Electronic Health Records (EHRs), insurance portals, and Microsoft Office tools.
+ Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
+ Experience or working knowledge with Collaborative MD and KIPU
+ Experience in detox and residential SUD programs.
+ Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna).
+ Strong clinical writing skills and familiarity with medical necessity language.
+ Ability to advocate for clients while balancing payer relationships and compliance.
+ Ability to lift up to 25 pounds.
+ Ability to walk up and down stairs during emergency drills or situations.
All ARS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates.
ARS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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Unlock Your Utilization Review Potential: Insight & Career Growth Guide
Real-time Utilization Review Jobs Trends in Englewood, United States (Graphical Representation)
Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for Utilization Review in Englewood, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 4402 jobs in United States and 2 jobs in Englewood. This comprehensive analysis highlights market share and opportunities for professionals in Utilization Review roles. These dynamic trends provide a better understanding of the job market landscape in these regions.
Great news! BriteLife Recovery is currently hiring and seeking a Utilization Review Specialist to join their team. Feel free to download the job details.
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An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at BriteLife Recovery adheres to the cultural norms as outlined by Expertini.
The fundamental ethical values are:The average salary range for a Utilization Review Specialist Jobs United States varies, but the pay scale is rated "Standard" in Englewood. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.
Key qualifications for Utilization Review Specialist typically include Other General and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.
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Here are some tips to help you prepare for and ace your job interview:
Before the Interview:To prepare for your Utilization Review Specialist interview at BriteLife Recovery, research the company, understand the job requirements, and practice common interview questions.
Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the BriteLife Recovery's products or services and be prepared to discuss how you can contribute to their success.
By following these tips, you can increase your chances of making a positive impression and landing the job!
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