Golden Gate Recovery is actively seeking a highly analytical and detail-oriented Utilization Review Specialist to join our dynamic team. As the Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and compliant utilization of resources while optimizing the quality of care for our clients.

Utilization Review: Conduct comprehensive reviews of client records to evaluate the appropriateness and necessity of treatment services, ensuring compliance with insurance and regulatory guidelines.

Authorization Management: Initiate, monitor, and maintain authorizations for services, following up as needed to secure additional authorizations and extensions.

Documentation: Maintain accurate and detailed records of utilization review activities, client authorizations, and communications with insurance providers.

Clinical Documentation: Collaborate with clinical staff to ensure accurate and timely documentation of treatment plans, progress notes, and client assessments.

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

Data Analysis: Collect and analyze utilization data to identify trends, opportunities for improvement, and areas of potential risk.

Compliance: Ensure compliance with all relevant insurance regulations, policies, and procedures, staying informed about changes and updates.

Communication: Serve as a liaison between the clinical team, billing department, and insurance providers to resolve utilization issues and facilitate reimbursement.

• Bachelor's degree in healthcare administration, psychology, or a related field. Master's degree preferred.
• Minimum of 3 years of utilization review experience in a healthcare or addiction treatment setting.
• In-depth knowledge of insurance regulations, authorization processes, and utilization review best practices.
• Strong analytical, organizational, and problem-solving skills.
• Excellent attention to detail and a commitment to maintaining the highest ethical standards.
• Effective communication and interpersonal skills.

Benefits:

• Competitive salary commensurate with experience.
• Comprehensive health and dental benefits.
• 401(k) retirement plan.
• Professional development opportunities.
• Supportive and collaborative work environment.
• Opportunity to make a meaningful impact on the quality and efficiency of client care at Golden Gate Recovery.