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Utilization Review Specialist (Non-Clinical)

J. Edward Staffing LLC

Deerfield Beach, FL

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JOB DETAILS
SKILLS
American Health Care Association (AHCA), Clinical Study Publications, Communication Skills, Documentation, FMLA (Family and Medical Leave Act of 1993), Insurance, Maintain Compliance, Medical Record System, Medical Records, Microsoft Office, Organizational Skills, Patient Confidentiality, Psychiatry and Mental Health, Psychology, Quality of Care, Regulatory Compliance, Regulatory Requirements, Social Work, Time Management, Treatment Evaluation, Utilization Management, Work From Home
LOCATION
Deerfield Beach, FL
POSTED
3 days ago
Job Title: Utilization Review Specialist
Utilization Review Specialist to work remotely. 13-week contract to cover FMLA. Mon - Fri 830a-5p. Will be working with 4 Lifeskills locations in FL. Will need to complete Florida ACHA background in addition to standard compliance checklist. Will interview with client. Submit with resume only.\n\nThe UR Specialist is responsible for reviewing clinical documentation to ensure medical necessity, appropriate level of care, and compliance with payer and regulatory requirements. This role works closely with clinical staff, admissions, and insurance providers to support timely authorizations, continued stay reviews, and quality patient care.\n\nKey Responsibilities:\n\n" Review patient records to verify medical necessity and appropriateness of services.\n\n" Conduct initial and concurrent reviews with insurance companies to obtain authorizations.\n\n" Prepare and submit clinical documentation for continued stay requests.\n\n" Track authorization status and maintain accurate documentation in the medical record.\n\n" Communicate effectively with clinical teams to obtain required information.\n\n" Assist with denial management and appeals as needed.\n\n" Ensure compliance with state, federal, and accreditation requirements (e.g., CARF, AHCA, DCF, etc.).\n\n" Maintain confidentiality of all patient and organizational information.\n\nQualifications:\n\n" Bachelor s degree in Mental Health, Social Work, Psychology, or related field (or equivalent experience).\n\n" 2 years of previous experience in utilization review or insurance authorization preferred.\n\n" Strong knowledge of medical necessity criteria (e.g., ASAM, LOCUS, InterQual).\n\n" Excellent communication, organizational, and time management skills.\n\n" Proficiency in electronic health records and Microsoft Office Suite.\n\n<

About the Company

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J. Edward Staffing LLC