[Hiring] Utilization Review Specialist @Banyan Treatment Centers

Role Description

We are seeking a Utilization Review Specialist to join our corporate team in Pompano Beach, FL. The position is responsible for contacting external case managers and managed care organizations for pre-authorization and concurrent reviews for the duration of a patient’s treatment stay. They also establish and maintain contracts with managed care companies and request rate increases when deemed appropriate.

Key Responsibilities

• Manage a caseload of 50–75 patients and authorize 15–25 cases daily, ensuring timely utilization reviews and appropriate level of care.
• Verify insurance benefits, coordinate authorizations, and communicate effectively with managed care providers.
• Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards.
• Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement.
• Identify and address over/underutilization trends and assist in resolving outstanding case issues with insurers.

Qualifications

• High School diploma or equivalent; graduate degree in a health or behavioral health related field preferred.
• Minimum of one-year experience working in a utilization review position (psychiatric or chemical dependency).

Benefits

• Medical, vision, and dental insurance.
• Whole and term life insurance.
• Short- and long-term disability coverage.
• 401(k) with employer match.
• Paid time off and holidays.
• Wellness, assistance, and referral programs.