Utilization Review Specialist
No salary listed
Junior, Mid
Bachelor's
Wyomissing, PA, USA+1 moreMore locations: Chadds Ford Township, PA, USA
HybridHybrid or remote eligible; options are based on business needs.
Medical, Clinical & Veterinary
About the job
Requirements
- A bachelor's degree in Healthcare Administration, Nursing, Social Work, Psychology, or a related field is required.
- At least 1–3 years of experience in utilization review, case management, or behavioral health revenue cycle is required.
- A strong understanding of medical necessity and authorization processes is required.
- Strong attention to detail and analytical skills are required.
- Strong written and verbal communication skills are required.
- Ability to manage multiple priorities and deadlines is required.
- Ability to collaborate across clinical, billing, and administrative teams is required.
- Commitment to compliance with regulatory and payer requirements is required.
- Ability to work hybrid or remotely depending on organizational needs is required.
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 electronic health record (EHR) and billing systems.
- Perform ongoing eligibility verification for active clients.
- Identify coverage changes and communicate their 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.
Desired Qualifications
- Experience with Pennsylvania and Ohio behavioral health payers.
- Familiarity with electronic health record (EHR) systems and billing workflows.
- Experience supporting audits, compliance reviews, or appeals.
About the company
Diversified Treatment Alternative Centers runs residential and outpatient mental health programs for children, adolescents and families in Pennsylvania, Ohio and Delaware. Its services address emotional distress, behavioral problems and the effects of physical, emotional and sexual abuse. Children receive individualized treatment in family-style residential settings, clinics, schools and community environments, with care intended to support a return to family and community life. The business earns fees for treatment, with residential funding through county child-serving agencies and Medicaid. Founded in 1991, it is headquartered in Milton, Pennsylvania.
Company Size
51-200
Company Stage
N/A
Total Funding
N/A
Headquarters
Milton, PA
Founded
1991
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Simplify's Take
What believers are saying
- Lewisburg technicians enter with paid training: the residential role accepts a high school diploma or equivalent.
- Cranberry therapists receive licensure support: the unlicensed mental health professional role includes clinical supervision.
- Cranberry scheduling accommodates availability: the therapist role adjusts to candidate and program needs; evenings are preferred, not required.
What critics are saying
- Specialist therapists split their week: the problematic sexual behaviors role assigns Lewisburg Monday-Tuesday and Danville Wednesday-Thursday.
- Lewisburg technician work includes nights: the residential posting lists an 11pm-7am shift alongside daytime and evening options.
- Pennsylvania residential care faces overlapping oversight: DTAC facilities hold licenses from both mental-health and child-welfare offices.
What makes Diversified Treatment Alternative Centers unique
- DTAC keeps intensive care within school hours: its partial hospitalization programs run five days weekly for ages 5-18.
- Ohio treatment follows a long course: its male residential program for ages 8-18 typically lasts 9-12 months.
- Pennsylvania residents receive onsite schooling: DTAC's residential programs include individualized instruction from certified special education teachers.
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