Utilization Review Specialist

The Utilization Review Specialist facilitates clinical reviews for patient admissions and continued stays, analyzing records to determine the legitimacy of treatment and length of stay. This role involves interfacing with managed care organizations and payers to advocate for patients, particularly those with substance abuse, psychiatric, or emotional disorders, to secure necessary coverage. The position requires completing pre- and re-certifications, managing appeals, and communicating with the interdisciplinary team to ensure documentation and authorization requirements are met.