Utilization Review Specialist - Addiction Recovery
Summit BHCAbout the Job:
PURPOSE STATEMENT:The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information; Educates hospital staff about requirements and trends.
Roles and Responsibilities:
What You’ll Do
You’ll play a key role in ensuring clients receive the care they need—while coordinating with insurance providers and clinical teams to support appropriate treatment and coverage.
Review cases for admission, continued stay, and discharge using hospital criteria
Communicate with insurance companies & managed care organizations to secure treatment approvals
Submit and manage appeals for denied services
Support pre-certifications and benefit verification for incoming clients
Maintain accurate documentation and utilization review records
Partner with physicians and clinical staff to ensure medical necessity and proper documentation
Identify and follow up on charting issues or deficiencies
Monitor length of stay and flag any concerns impacting treatment or coverage
Collaborate with the business office to resolve payment or authorization issues
Participate in discharge planning and care coordination
Track and report utilization data, trends, and outcomes
Assist with audits, peer reviews, and third-party payer reviews
Serve as a liaison between clinical teams and insurance providers
What You Bring
High School Diploma or equivalent (required)
1+ year of clinical experience in substance use or behavioral health (required)
Experience with ASAM criteria (preferred)
Utilization Review experience (preferred)
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.