Utilization Review Specialist — Remote (Part-Time to Full-Time)
Rise and Renew
Rise and Renew is a behavioral health and addiction treatment organization dedicated to helping individuals reclaim their lives through compassionate, evidence-based care. We're looking for a detail-oriented Utilization Review Specialist to join our team remotely and play a key role in ensuring our clients receive the care they need at every stage of treatment.
About the Role
As our Utilization Review Specialist, you'll serve as the bridge between our clinical team and insurance payers — advocating for medically necessary care by securing authorizations, conducting concurrent reviews, and managing appeals. Your work directly supports client access to detox and residential levels of care.
What You'll Do
- Conduct pre-certification, initial, and concurrent utilization reviews with commercial and managed care payers
- Present clinical information clearly and persuasively to secure authorizations for appropriate levels of care using ASAM criteria
- Track authorization timelines and ensure reviews are completed before expiration to prevent gaps in coverage
- Collaborate with clinical, admissions, and billing teams to gather documentation supporting medical necessity
- Manage denials by initiating appeals and coordinating peer-to-peer reviews with our clinical leadership
- Maintain accurate, timely records of all reviews, authorizations, and payer communications in the EMR
- Stay current on payer requirements, ASAM criteria updates, and industry best practices
What We're Looking For
- Experience in utilization review, case management, or clinical documentation in a behavioral health or substance use treatment setting
- Working knowledge of ASAM 3 and 4 criteria and levels of care in addiction treatment
- Familiarity with commercial insurance, managed care processes, and prior authorization workflows
- Strong written and verbal communication skills — you can summarize a clinical picture concisely and advocate effectively
- Highly organized, deadline-driven, and comfortable working independently in a remote setting
- Proficiency with EMR systems and payer portals
Preferred (Not Required)
- Experience with appeals and peer-to-peer review coordination
Position Details
- Fully remote
- Flexible scheduling — position can begin part-time with the opportunity to grow into full-time
- Supportive, mission-driven team environment
Pay: $25.00 - $28.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: Remote
