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Utilization Review Specialist
Diversified Treatment Alternative Centers (DTAC). Conduct initial, concurrent, and continued stay utilization reviews .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting utilization reviews, managing authorizations, and ensuring compliance with medical necessity and payer requirements. Proficient in collaborating with clinical and administrative teams to optimize revenue cycle processes and maintain accurate documentation.
Highest-signal resume keywords
Utilization ReviewMedical NecessityAuthorization ProcessesEHR SystemsBehavioral Health Revenue Cycle
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ReviewAuthorization ManagementEligibility VerificationClinical Documentation ReviewCompliance AuditsRevenue Cycle OptimizationAppeals SupportQuality Improvement InitiativesAttention to DetailAnalytical Skills
Soft Skills
Strong Communication SkillsCollaborationAbility to Manage Multiple Priorities
Tools & Technologies
EHR SystemsBilling Systems
Industry Keywords
Healthcare AdministrationBehavioral HealthPayer RequirementsRegulatory CompliancePennsylvania Behavioral Health PayersOhio Behavioral Health Payers
About the role
Key responsibilities & impact- Conduct initial, concurrent, and continued stay utilization reviews
- Submit, track, and manage authorizations and reauthorizations
- Communicate authorization updates with clinical and admissions teams
- Maintain accurate documentation in EHR and billing systems
- Perform ongoing eligibility verification for active clients
- Identify coverage changes and communicate impacts to appropriate teams
- Review clinical documentation for medical necessity and compliance
- Collaborate with clinicians to address documentation gaps
- Support denial prevention and revenue cycle optimization
- Assist with appeals and utilization-related inquiries
- Participate in audits, quality improvement initiatives, and compliance reviews
- Stay current with payer requirements and regulatory updates
- Collaborate with Clinical, Admissions, and Revenue Cycle teams to ensure compliance, minimize denials, and support accurate billing and reimbursement
Requirements
What you’ll need- Bachelor’s degree in Healthcare Administration, Nursing, Social Work, Psychology, or related field
- Minimum of 1–3 years of experience in utilization review, case management, or behavioral health revenue cycle
- Strong understanding of medical necessity and authorization processes
- Excellent attention to detail and analytical skills
- Strong written and verbal communication skills
- Experience with Pennsylvania and Ohio behavioral health payers preferred
- Familiarity with EHR systems and billing workflows preferred
- Experience supporting audits, compliance reviews, or appeals preferred
- Ability to manage multiple priorities and deadlines
- Strong collaboration across clinical, billing, and administrative teams
- Commitment to compliance with regulatory and payer requirements
- Ability to work hybrid or remotely depending on organizational needs
Benefits
Comp & perks- Flexible hybrid or remote work options
- Collaborative, cross-functional team environment
- Meaningful work supporting behavioral health services
- Stable organization focused on quality and growth
- Opportunities for professional development
- 401(k)
- Health, Dental, and Vision Insurance
- Health Savings Account
- Paid Time Off
- Life and Disability Insurance
- Employee Assistance Program
- Referral Program