Utilization Review Specialist

Northpoint Recovery

. Ensure clinically appropriate care, discharge, and cost-effective utilization of services across the treatment continuum .

Posted 11/12/2026full-timeRemote • Idaho • United StatesJunior💰 $30 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical review processes, ensuring appropriate care and cost-effective service utilization while maintaining compliance with ethical standards and confidentiality requirements. Proficient in communication with multidisciplinary teams and third-party payers to facilitate patient care and manage appeals effectively.

Highest-signal resume keywords

Clinical ReviewUtilization ManagementActive Licensure in Substance Abuse or Mental HealthCritical ThinkingMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical JudgmentTreatment Plan ImplementationData Collection and AnalysisDocumentation AccuracyAppeals Preparation

Soft Skills

Excellent Communication SkillsOrganizational AbilitiesAttention to DetailDiscretion and Independent JudgmentRapport Building

Certifications & Qualifications

Master’s Degree in Social SciencesActive State Licensure

Industry Keywords

HIPAA ComplianceMedical Necessity CriteriaLength of Stay VarianceThird-Party Payer CommunicationMultidisciplinary Team Collaboration

About the role

Key responsibilities & impact

Ensure clinically appropriate care, discharge, and cost-effective utilization of services across the treatment continuum
Provide ongoing clinical review of patients from admission through discharge in conjunction with a multidisciplinary team
Lead timely and clinically sound reviews and responses for admissions, continued stays, discharges, and appeals
Serve as a liaison between payers and clinical care teams
Apply utilization criteria to monitor admissions, levels of care, and continued stays
Communicate with third-party payers for initial and concurrent clinical review
Review patient charts to ensure continued medical necessity
Document actions and information shared with care team members or third-party payers
Alert clinical care teams and management when patients no longer meet medical necessity criteria
Refer cases exceeding expected length of stay, cost, or resource utilization to management
Perform verbal/fax clinical reviews with payers
Collect data on length-of-stay variances, lost days, costs, discharge barriers, transitions, and denied days
Prepare appeals on denied cases when appropriate
Adhere to company policies, confidentiality requirements, and standards of care
Perform other job-related duties as assigned

Requirements

What you’ll need

Master’s Degree of Social Sciences or commensurate experience required
Must hold an active substance abuse or mental health licensure in the state where treatment services are rendered
Must maintain applicable state licensure requirements at hire, and for the entire duration of employment
1+ year of experience in relevant field required
Must be able to exercise discretion and independent judgment in all areas of job performance including adherence to appropriate professional boundaries and strict confidentiality practices in regard to client activities and documentation
Able to apply clinical judgment, ethics and accountability to formulate and implement treatment plans and other clinical documentation
Must hold strong personal boundaries and able to build rapport with patients and staff
Must understand and adhere to the ethical standards of the respective licensure governing board
Excellent critical thinking skills
Excellent organizational abilities
Excellent communication skills; ability to communicate clearly and concisely, verbally and in writing
Quickly and effectively identify and resolve problematic situations
Comfortable analyzing information and dealing with complexity
Attention to detail and accuracy
Able to handle confidential material in a reliable manner
Ability to interact and communicate with individuals at all levels of organization
Ability to perform several tasks concurrently with ease and professionalism
Ability to effectively prioritize workload in a fast-paced environment
Proficiency with Microsoft Office Suite
Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA

Benefits

Comp & perks

Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s)
100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000
100% Employer Paid Employee Assistance Program
Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance
Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses
Generous Paid Time Off plan
Employee Referral Bonuses
401K Retirement Plan & Employer Match