As the Utilization Review Specialist at Santa Barbara Recovery, you will play a vital role in the assessment of treatment plans, utilization of resources, and coordination of care for our clients. Your expertise will ensure that our clients receive the highest quality of care while optimizing the utilization of healthcare resources.

Utilization Review: Conduct comprehensive reviews of client treatment plans and progress to ensure they meet medical necessity criteria and comply with regulatory requirements.

Insurance Verification: Verify clients' insurance coverage, benefits, and pre-authorization requirements, obtaining authorizations for services when necessary.

Clinical Documentation: Review and analyze clinical documentation to ensure accuracy, completeness, and compliance with billing and regulatory standards.

Continuum of Care: Collaborate with the clinical team to assess clients' progress, treatment goals, and the appropriateness of continued care.

Appeals and Denials: Assist in the preparation of appeals for denied claims, providing necessary documentation and information to support the appeal process.

Resource Optimization: Identify opportunities to optimize the utilization of resources while maintaining the highest level of client care.

Data Analysis: Analyze utilization data and trends to identify areas for improvement and inform decision-making.

Regulatory Compliance: Stay current with federal, state, and local regulations related to utilization review, billing, and reimbursement.

Collaboration: Work closely with the billing department, clinical team, and external payers to resolve utilization-related issues.

• Bachelor's degree in Healthcare Administration, Nursing, or a related field (Master's degree is a plus).
• Minimum of 2 years of experience in utilization review or related roles, preferably in an addiction treatment or healthcare setting.
• Strong knowledge of insurance verification, authorization processes, and billing practices.
• Excellent analytical and problem-solving skills.
• Detail-oriented with a high degree of accuracy in data analysis and documentation.
• Ability to communicate effectively and collaborate with a multidisciplinary team.
• Familiarity with electronic health record (EHR) systems is desirable.

How to Apply:

Interested candidates are invited to submit their resume, cover letter, and references to Adam@santabarbararecovery.com. Please include "Utilization Review Specialist Application" in the subject line.

Santa Barbara Recovery is committed to creating an inclusive and supportive work environment. We welcome candidates from diverse backgrounds to apply.

If you are a detail-oriented professional with a commitment to optimizing the utilization of healthcare resources and ensuring the highest quality of care for individuals in addiction treatment, we look forward to receiving your application. Join us in our mission to provide outstanding care and support for individuals seeking transformation and healing.

Santa Barbara Recovery is an equal opportunity employer.