Utilization Review (UR) Specialist @Spectrum Billing Solutions

[Hiring] Utilization Review (UR) Specialist @Spectrum Billing Solutions

Mar 21, 2025 - Spectrum Billing Solutions is hiring a remote Utilization Review (UR) Specialist. 💸 Salary: competitive salary. 📍Location: USA.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

This role involves reviewing clinical information and obtaining authorizations for behavioral healthcare services.

Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
Obtain initial and continuing authorization for treatment services.
Manage authorization denials including referral for peer review.
Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment.
Advocate on behalf of patients to ensure maximum length of stay at the appropriate level of care.
Interact with insurance companies in a respectful, professional manner that facilitates the utilization review process and follows policies and procedures.
Document and record all necessary information.
Monitor and track new and ongoing authorization cases.
Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
Participate in team meetings and case conference reviews.
Perform other duties as assigned.
Maintain confidentiality of patient information and adhere to HIPAA regulations.

Qualifications

3-5 years of related ABA, Substance Abuse, and/or Mental Health experience.
Bachelor’s or master’s degree preferred.
Superior written and oral communication skills.
Attention to detail to ensure necessary information is captured and properly documented.
Ability to work independently and within a team.
Ability to multi-task, prioritize and meet expected deadlines.
Solid understanding of insurance benefits and coverages.
Strong computer skills (Word, Excel, billing software).
Understanding of mental and behavioral health treatment services.

Benefits

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📍	Be aware of the location restriction for this remote position: USA
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Utilization Review (UR) Specialist @Spectrum Billing Solutions

All others

Salary 💸 competitive salary	Remote Location USA
Job Type full-time	Posted Mar 21, 2025

️

📍	Be aware of the location restriction for this remote position: USA
‼	Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.