Utilization Review Specialist (in-office only) in Boca Raton, Florida at 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 - 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 authorizations—it’s 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

• Advocate for patients by presenting strong clinical justifications to insurance payers.
• Apply medical necessity criteria to obtain and maintain authorizations across all levels of care.
• Resolve complex authorization issues with proactive thinking and problem-solving.

Facility Collaboration & Clinical Quality Management

• Partner with treatment center clinical teams to align care plans with payer requirements.
• Offer guidance on documentation improvements and trends in payer behavior.
• Serve as the main liaison between providers and the billing team to ensure smooth coordination.

Communication & Case Management

• Communicate clearly and professionally with facility staff, insurance representatives, and internal teams.
• Manage a caseload of 50–70 patients, ensuring timely follow-ups and precise documentation.
• Maintain thorough and up-to-date records in EMR (Kipu required) and authorization trackers.
• Escalate denied or pended cases as needed via peer reviews or appeals.

Operational Excellence & Technology Utilization

• Utilize EMR systems (Kipu required) and Google Workspace tools (Docs, Sheets, Drive).
• Support after-hours utilization reviews to ensure continuity and compliance.
• Stay informed on payer policy changes and communicate updates to partner facilities.

What You'll Bring:

• Minimum 3 years of clinical experience in behavioral health or substance abuse settings, with a strong understanding of medical necessity criteria.
• Significant experience in UR, case management, or insurance authorization processes (not entry-level).
• Proficiency with Kipu EMR and Google Workspace.
• Strong organizational and communication skills.
• Strong verbal and written communication skills with both internal teams and external payers.
• Exceptional problem-solving skills and the ability to think strategically to obtain approvals.
• Ability to multitask, stay organized, and manage a large caseload efficiently.
• Customer service mindset—ability to foster strong relationships with facilities and serve as a trusted resource.
• Understanding that UR is not just about approvals—it’s about clinical integrity, compliance, and bridging the gap between care teams 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.

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