Utilization Review Specialist (Per Diem)
On-siteDeerfield Beach, Florida, United States
Job Summary
Manage all clinical authorization processes to ensure timely, accurate, and compliant communication with insurance payers. Secure initial and continued-stay authorizations, prevent avoidable denials, and collaborate with clinical teams to ensure documentation reflects medical necessity according to payer guidelines. Maximize reimbursement, maintain compliance, and support quality patient care throughout the behavioral health and addiction treatment continuum. This per diem, as-needed position requires a Bachelor's degree in Nursing, Social Work, or Behavioral Health with 2-3 years of utilization review experience. Strong understanding of ASAM criteria, LOCUS, DSM-5, and diagnostic standards is essential, along with excellent clinical summarization and documentation review skills.
Required Qualifications
- Bachelor's Degree from accredited college or university in Nursing, Social Work, Behavioral Health or related field
- 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
- This is a per diem, as-needed position with no guaranteed hours
Desired Qualifications
- Bachelor's Degree from accredited college or university in Nursing, Social Work, Behavioral Health or related field preferred
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