Utilization Review Specialist

Company: Quadrant Health Group
Location: Boca Raton
Posted on: May 23, 2025

Job Description:

This is an in office position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be considered.--A growing, reputable provider of specialized medical billing services for behavioral health and substance abuse treatment centers is seeking an experienced Utilization Review (UR) Specialist to join our dynamic and fast-paced team. This is a confidential opportunity ideal for a professional with 5+ years of clinical experience and a strong background in utilization review.The selected candidate will play a vital role in connecting clinical care delivery with revenue cycle outcomes. This position requires advanced clinical reasoning, payer knowledge, and the ability to act as a liaison between treatment providers and insurance companies.Key ResponsibilitiesClinical AdvocacyAdvocate for patients by presenting strong clinical justifications to insurance payers.Apply medical necessity criteria to obtain and maintain authorizations across all levels of care.Resolve complex authorization issues with proactive thinking and problem-solving.Facility Collaboration & Clinical Quality ManagementPartner with treatment center clinical teams to align care plans with payer requirements.Offer guidance on documentation improvements and trends in payer behavior.Serve as the main liaison between providers and the billing team to ensure smooth coordination.Communication & Case ManagementCommunicate clearly and professionally with facility staff, insurance representatives, and internal teams.Manage a caseload of 50-70 patients, ensuring timely follow-ups and precise documentation.Maintain thorough and up-to-date records in EMR (Kipu required) and authorization trackers.Escalate denied or pended cases as needed via peer reviews or appeals.Operational Excellence & Technology UtilizationUtilize EMR systems (Kipu required) and Google Workspace tools (Docs, Sheets, Drive).Support after-hours utilization reviews to ensure continuity and compliance.Stay informed on payer policy changes and communicate updates to partner facilities.RequirementsMinimum 5 years of clinical experience in behavioral health or substance abuse settings.Significant experience in utilization review required (not entry-level).Proficiency with Kipu EMR and Google Workspace.Strong organizational and communication skills.Strong verbal and written communication skills with both internal teams and external payers.Ability to multitask, stay organized, and manage a large caseload efficiently.--Customer service mindset-ability to foster strong relationships with facilities and serve as a trusted resource.Understanding that UR is not just about approvals-it's about clinical integrity, compliance, and bridging the gap between care teams and financial sustainabilityCompensation details: 60000-80000 Yearly SalaryPIefd16e663a6e-25660-37423006

Keywords: Quadrant Health Group, Tamiami , Utilization Review Specialist, Other , Boca Raton, Florida