Utilization Review Specialist
On-site · Fort Worth, Texas, United States
Job Summary
Utilization Review Specialist at Clearfork Academy focusing on verifying insurance benefits and eligibility before client admission, coordinating authorization requests, concurrent reviews, and re-certifications with insurance providers, reviewing clinical documentation to support medical necessity and level-of-care determinations, advocating for appropriate treatment authorization and appeals, maintaining accurate records of authorizations, denials, and insurer communications, collaborating with therapists, nursing staff, medical providers, and administrative teams to support quality care and treatment continuity, communicating clinical information effectively to insurance case managers and healthcare partners, participating in treatment team meetings and discharge planning, monitoring client charts for payer compliance, resolving authorization discrepancies and reimbursement issues, responding promptly to inquiries related to utilization review, supporting billing and collections through timely authorization management, and contributing ideas for process improvements.
Required Qualifications
- Bachelor's Degree in Social Work, Psychology, Nursing, Healthcare Administration, or related field
- 1–3 years of experience in utilization review, medical billing, insurance authorization, healthcare administration, medical office operations, or related healthcare settings required
- LCDC, Nursing, Social Work, Counseling, or other relevant clinical licensure preferred
- Experience working in behavioral health, substance abuse treatment, mental health services, or healthcare settings preferred
Apply with one swipe on Sorce. We auto-fill applications and apply on your behalf — no cover letters, no 40-minute forms.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.