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Utilization Review Specialist - Supporting Recovery across NJ, FL, & CA

All In Solutions -
Remote

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Job Details

Full-time
From $55,000 a year
6 days ago

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance

Qualifications

Behavioral health hospital experience
Teamwork
Writing skills
Substance abuse treatment center experience
Mental health facility experience
Case management
Clinical documentation
Resource utilization in healthcare
Experience working with individuals with substance use disorders

Full Job Description

About Us – Mission & Values

At All In Solutions, our mission is to provide quality, evidence-based treatment that leads to long-term recovery for every client who walks through our doors. We believe that connection and purpose are essential to this pursuit, guiding every decision we make and every service we provide.

Position Summary

The Utilization Review (UR) Specialist is a critical, hands-on role dedicated to bridging the gap between clinical excellence and financial sustainability. You will be responsible for ensuring that all client admissions, continued stays, and services meet strict clinical necessity criteria while adhering to payer requirements and state/federal regulations. Your expertise will directly secure authorizations, minimize denials, and maintain the high compliance standards across our behavioral health and Substance Use Disorder (SUD) programs.

Core Responsibilities

Authorization Management: Conduct and submit timely, accurate pre-certifications, concurrent reviews, and continued stay authorizations across all levels of care (Detox, Residential, PHP, and IOP).
Clinical Justification: Proficiently utilize and document against established medical necessity criteria, including ASAM, LOCUS, and InterQual, to support treatment justification.
Appeals & Grievances: Prepare and submit clear, clinically sound documentation for initial-stage denial appeals and grievance processes.
EMR Integrity: Maintain meticulous, organized UR documentation within the Electronic Medical Record (EMR), ensuring all records are "audit-ready" at all times.
Payer Relations: Serve as a professional point of contact for routine communications with insurance representatives regarding authorization requests and follow-ups.
Collaborative Compliance: Partner with the UR Manager and clinical teams to ensure documentation aligns with state licensing (NJ DOH, FL DCF, CA DHCS) and accreditation standards (CARF/Joint Commission).
Industry Expertise: Stay current on evolving payer guidelines, medical necessity criteria, and state/federal regulations impacting the UR landscape.

Candidate Qualifications

Education: Bachelor’s degree in Healthcare Administration, Social Work, Nursing, Psychology, or a related field (or equivalent professional experience).
Experience: Minimum of 2 years of hands-on utilization review or case management experience specifically in an inpatient behavioral health or SUD setting.
Clinical Knowledge: Direct proficiency in applying ASAM Criteria for patient placement and continued stay justification.
Communication: Exceptional clinical writing skills with the ability to craft compelling justifications for review submissions.
Technical Skills: Proficiency with Kipu EMR and standard UR tracking/submission tools is highly preferred.

Key Compliance Competencies

Regulatory Knowledge: Practical working knowledge of state-specific licensure regulations, including: NJ: NJAC Title 10:161A & 10:161B, FL: Florida Administrative Code Chapter 65D-30, CA: Title 9 CCR, Chapter 11
Payer Versatility: Familiarity with UR processes for Medicaid, Medicare, and commercial payers in a multi-state environment.
Attention to Detail: A meticulous approach to file maintenance, ensuring total readiness for payer audits and state licensing bodies.

Why Join All In Solutions?

We offer a supportive, remote work environment where your work directly impacts a client's ability to access life-saving care. If you are a detail-oriented advocate with a passion for behavioral health compliance, we want to hear from you.

Your skills. Our mission. A brighter future for recovery. Ready to use your expertise to clear the path for life-changing recovery? Join our growing team. Apply now and be ALL IN!

Job Type: Full-time

Pay: From $55,000.00 per year

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance

Application Question(s):

Have you done MH/SUD facility utilization review?
Have you worked with KIPU EMR?
Please list the specific levels of care in which you have professional experience (e.g., Detox, Residential/Inpatient, PHP, IOP, or Outpatient)

Work Location: Remote

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