Utilization Review Specialist (in-office only) NEW

Boca Raton, Florida
Quadrant Health Group

Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions,a proud member of the Quadrant Health Group, is seeking a passionate and dedicated Utilization Review Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively.

Why Join Quadrant Health Group?

• Competitive salary commensurate with experience.
• Comprehensive benefits package, including medical, dental, and vision insurance.
• Paid time off, sick time and holidays.
• Opportunities for professional development and growth.
• A supportive and collaborative work environment.
• A chance to make a meaningful impact on the lives of our clients.

Compensation:$60,000 – $75,000 a year – (Based on experience) Full-time

What You’ll Do:

The UR Specialist plays a critical role in ensuring both clinical quality management and financial viability for our partner facilities. This position is not just about securing authorizationsits about bridging the gap between clinical care and revenue cycle management. UR Specialists serve as the direct liaison between facility clinical teams, insurance providers, and the billing department, ensuring seamless communication, accurate documentation, and optimal patient outcomes.

This is an in-office position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be considered.

Key Responsibilities

Clinical Advocacy

• Serve as a strong patient advocate, effectively communicating clinical justifications to insurance payers.
• Apply medical necessity criteria to secure initial and continued authorizations across all levels of care.
• Utilize problem-solving and critical thinking to navigate complex authorization issues and minimize denials.

Facility Collaboration & Clinical Quality Management

• Work closely with clinical teams to ensure treatment plans align with insurance criteria for continued authorization.
• Provide ongoing feedback to facilities regarding documentation improvements, level of care justifications, and payer trends.
• Serve as the primary point of contact between facilities and the billing team, ensuring smooth coordination and timely approvals.
• Proactively educate and guide facilities on insurance requirements, helping them adapt to payer expectations.

Communication & Case Management

• Maintain clear, professional, and proactive communication with facility staff, insurance representatives, and internal billing teams.
• Manage a caseload of 50-70 patients, ensuring timely follow-ups, thorough documentation, and strong attention to detail.
• Document all interactions in the EMR (Kipu experience required) and ensure all authorization trackers are up to date.
• Ensure that denied or pended cases are escalated appropriately through peer reviews or appeals.

Operational Excellence & Technology Utilization

• Efficiently navigate EMR systems (Kipu experience required)
• Utilize Google Docs, Google Sheets, and Google Drive for internal reporting, tracking, and collaboration.
• Assist in after-hours utilization reviews as needed to prevent service disruptions and maintain compliance.
• Adapt quickly to payer policy changes and ensure facilities are informed of updates that impact clinical documentation and authorization processes.

What Were Looking For

• Minimum of 3 years of clinical experience in behavioral health, with a solid grasp of medical necessity criteria and levels of care.
• Prior experience in utilization review, case management, or insurance authorization within the behavioral healthcare space.
• Strong analytical and problem-solving abilities, with the capacity to think strategically and advocate effectively for treatment approvals.
• Excellent written and verbal communication skills, with the ability to collaborate across internal teams and external stakeholders.
• Highly organized and detail-oriented, capable of managing a high-volume caseload in a fast-paced environment.
• Proficiency in Kipu EMR and Google Workspace tools (Drive, Sheets, Docs) is required.
• Customer-focused mindset with the ability to build and maintain strong relationships with partner facilities and serve as a reliable, knowledgeable resource.
• A clear understanding that utilization review is not solely about approvals, it’s about upholding clinical integrity, ensuring compliance, and supporting the intersection of quality care and financial sustainability.

About Quadrant Billing Solutions:

At Quadrant Billing solutions, we believe in fostering a culture of compassion, innovation, and excellence. We are dedicated to empowering individuals to achieve their optimal health and well-being. Our team is comprised of highly skilled professionals who are passionate about making a difference in the lives of those we serve. Join us and be part of a team that values your contributions and supports your professional growth.

Compensation details: 0 Yearly Salary

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