Utilization Review & Quality Assurance Specialist
Lifeline Recovery Center
Full-Time | Monday–Friday
Job Summary
Lifeline Recovery Center is seeking a highly motivated, organized, and detail-oriented Utilization Review and Quality Assurance Specialist to join our growing behavioral health team. This position plays a vital role in ensuring clinical services are medically necessary, appropriately authorized, accurately documented, and compliant with payer, state, ASAM, and CARF standards.
The UR/QA Specialist will work collaboratively with Clinical, Admissions, Billing, and Leadership teams to support timely authorizations, reduce denials, strengthen documentation quality, and promote ongoing regulatory and quality improvement efforts across our residential and outpatient programs.
This role is ideal for someone who enjoys both utilization management and quality improvement, has strong attention to detail, and is passionate about supporting high-quality substance use and behavioral health treatment services.
We offer competitive pay based on experience.
Essential Job Duties Utilization Review Responsibilities
- Conduct initial, concurrent, and continued stay reviews to determine medical necessity and appropriate level of care
- Submit, track, and manage prior authorizations, reauthorizations, and concurrent reviews with insurance providers and managed care organizations
- Verify insurance eligibility and benefits and monitor coverage throughout treatment episodes
- Maintain timely and accurate authorization documentation within the Electronic Health Record (EHR) and billing systems
- Communicate authorization requirements, approvals, denials, and coverage concerns to Admissions, Clinical, and Billing teams
- Assist with appeals, peer reviews, and medical necessity disputes when indicated
- Monitor payer requirements and maintain knowledge of Medicaid, commercial insurance, and behavioral health authorization processes
- Identify and address utilization concerns that may impact reimbursement or continuity of care
Quality Assurance & Compliance Responsibilities
- Review clinical documentation to ensure medical necessity, regulatory compliance, and alignment with payer expectations
- Monitor documentation quality, timeliness, and consistency across treatment records
- Collaborate with clinicians and program staff to resolve documentation gaps and support corrective action when needed
- Assist with internal audits, quality improvement projects, and survey readiness activities related to CARF, ASAM, and state licensing requirements
- Support development and monitoring of performance improvement initiatives and quality indicators
- Maintain confidentiality and ensure compliance with HIPAA and organizational policies
- Assist leadership with tracking trends, identifying areas for improvement, and strengthening overall program quality and compliance
Qualifications
Preferred Qualifications:
- 1–3 years of experience in Utilization Review, Quality Assurance, Medical Records, or Behavioral Health Compliance
- Experience working in behavioral health, substance use treatment, or healthcare settings preferred
- Knowledge of medical necessity criteria, authorization processes, and payer requirements
- Familiarity with ASAM criteria, CARF standards, and behavioral health documentation requirements preferred
- Experience with Electronic Health Records (Sunwave experience is a plus)
- Understanding of HIPAA, clinical documentation standards, and healthcare regulations
- Strong organizational, analytical, and communication skills
- Ability to manage multiple priorities while maintaining accuracy and professionalism
What We Offer
At Lifeline Recovery Center, we are committed to providing compassionate, evidence-based, and recovery-focused care. We value teamwork, integrity, and professional growth while working together to help individuals build healthier, purpose-driven lives.
Join a mission-driven team where your work directly impacts client care, program quality, and long-term recovery outcomes.
Benefits:
- 401(k)
- Health insurance
- Life insurance
- Paid time off
Application Question(s):
- Do you live in the state of Kentucky?
- Are you willing and able to pass a drug screen?
- How many years of experience do you have in UR/QA?
Work Location: Hybrid remote in Paducah, KY 42001
