Utilization Review Specialist

🕒 July 22

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Bradford Health Services

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1977

🏥 Healthcare

🧘 Wellness

🤝 Non-profit

Healthcare • Wellness • Non-profit

Bradford Health Services is a leading provider of addiction treatment programs, offering a wide range of services to support individuals in their recovery journey. With facilities across the Southeast, they provide inpatient and outpatient rehabilitation, detox services, and various specialty programs tailored to meet the unique needs of their patients. Their commitment to affordable, evidence-based treatment ensures that individuals can access the support they need to reclaim their lives from addiction.

📋 Description

• Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services. • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details. • Make informed decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements. • Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards. • Stay current with evolving healthcare regulations, payer policies, and clinical best practices to ensure consistent and compliant review processes.

🎯 Requirements

• Bachelor’s degree in Nursing, Health Administration, or a related healthcare field. • At least 2 years of experience in utilization review, case management, or clinical healthcare roles. • Strong knowledge of medical terminology, clinical procedures, and healthcare regulations. • Familiarity with insurance authorization processes and healthcare reimbursement models. • Excellent analytical, communication, and organizational skills. • Registered Nurse (RN) license or equivalent clinical certification (preferred). • Experience with electronic health records (EHR) systems and utilization management software (preferred). • Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager) (preferred). • Advanced knowledge of Medicare, Medicaid, and other payer-specific guidelines (preferred).

🏖️ Benefits

• Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits. • Expanded Coverage – Options for domestic partners and a wider network of in-network providers. • Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching. • Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more. • Student Loan Repayment – Available for nurses and therapists. • Retirement Benefits – 401(k) plan through Voya to help employees plan for the future. • Generous PTO – A robust paid time off policy to support work-life balance. • Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.