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 Advocacy

• Advocate 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 Management
  • Partner 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 Management
    • Communicate 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 Utilization
      • Utilize 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.Requirements
        • Minimum 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 sustainability
          
          
          Compensation details: 60000-80000 Yearly Salary
          
          
          
          PI58a99baff06e-37248-37423006

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