[Hiring] Utilization Review Specialist @The Florida House

Role Description

We are seeking an experienced specialist who is passionate about making a difference in the lives of individuals battling behavioral health and substance use disorder challenges.

• Responsible for managing all clinical authorization processes to ensure timely, accurate, and compliant communication with insurance payers.
• This role supports patient access to treatment by securing initial and continued-stay authorizations, preventing avoidable denials, and collaborating with clinical teams to ensure documentation reflects medical necessity according to payer guidelines.
• The UR Specialist helps maximize reimbursement, maintain compliance, and support quality patient care throughout the behavioral health and addiction treatment continuum.

Qualifications

• Bachelor’s Degree from accredited college or university in Nursing, Social Work, Behavioral Health or related field required preferred.
• 2-3 years of utilization review experience in behavioral health, addiction treatment, or managed care.
• Strong understanding of ASAM criteria, LOCUS, DSM-5, diagnostic standards, and documentation requirements.
• Excellent clinical summarization and documentation review skills.
• Strong communication with clinical teams and insurance reviewers.
• Ability to problem-solve, escalate appropriately, and manage time-sensitive deadlines.
• High attention to detailed accuracy.

Benefits

• Medical, Dental, and Vision Insurance
• Supplemental Life & Disability Insurance
• 401(k) Retirement Plan
• Generous PTO & Vacation Time
• Employee Assistance Program
• Opportunities for Professional Growth & Development
• Free CEU’s
• Free CPR Certification
• Free Crisis Prevention Certification (CPI)