Utilization Review Specialist

Utilization Review (UR) Specialist
Location: Open to candidates near Wyomissing PA & Chadds Ford PA (Hybrid / Remote Eligible)
Job Type: Full-Time
Schedule: Monday – Friday
Overview
Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented and experienced Utilization Review (UR) Specialist to support our behavioral health programs.
This role plays a critical part in ensuring services are medically necessary, appropriately authorized, and compliant with payer, state, and regulatory requirements while supporting timely reimbursement and quality care delivery.
Why Join DTAC
Flexible hybrid or remote work options
Collaborative, cross-functional team environment
Meaningful work supporting behavioral health services
Stable organization focused on quality and growth
Opportunities for professional development
Position Summary
The Utilization Review Specialist manages the full lifecycle of authorizations and eligibility verification. This role collaborates closely with Clinical, Admissions, and Revenue Cycle teams to ensure compliance, minimize denials, and support accurate billing and reimbursement.
Key Responsibilities
Conduct initial, concurrent, and continued stay utilization reviews
Submit, track, and manage authorizations and reauthorizations
Communicate authorization updates with clinical and admissions teams
Maintain accurate documentation in EHR and billing systems
Perform ongoing eligibility verification for active clients
Identify coverage changes and communicate impacts to appropriate teams
Review clinical documentation for medical necessity and compliance
Collaborate with clinicians to address documentation gaps
Support denial prevention and revenue cycle optimization
Assist with appeals and utilization-related inquiries
Participate in audits, quality improvement initiatives, and compliance reviews
Stay current with payer requirements and regulatory updates
Qualifications
Required:
Bachelor’s degree in Healthcare Administration, Nursing, Social Work, Psychology, or related field
Minimum of 1–3 years of experience in utilization review, case management, or behavioral health revenue cycle
Strong understanding of medical necessity and authorization processes
Excellent attention to detail and analytical skills
Strong written and verbal communication skills
Preferred:
Experience with Pennsylvania and Ohio behavioral health payers
Familiarity with EHR systems and billing workflows
Experience supporting audits, compliance reviews, or appeals
Requirements
Ability to manage multiple priorities and deadlines
Strong collaboration across clinical, billing, and administrative teams
Commitment to compliance with regulatory and payer requirements
Ability to work hybrid or remotely depending on organizational needs
Benefits
401(k)
Health, Dental, and Vision Insurance
Health Savings Account
Paid Time Off
Life and Disability Insurance
Employee Assistance Program
Referral Program
Work Location
Open to candidates near Chadds Ford, PA (19317) and Wyomissing PA (19610) with hybrid or remote work options available based on business needs.
Apply Today
If you are a detail-driven professional with experience in utilization review or behavioral health operations, we encourage you to apply and join DTAC’s team.
Equal Opportunity Employer
Diversified Treatment Alternative Centers is committed to providing equal employment opportunities and maintaining an inclusive workplace in accordance with all applicable laws.

Employment type
Full-Time

Work arrangement
No