What are the responsibilities and job description for the Utilization Review Behavioral Specialist position at Bridge Counseling Associates (BCA)?
About us
Bridge Counseling Associates, a premier non-profit Certified Community Behavioral Health Clinic (CCBHC) serving Southern Nevada since 1971, is seeking an on-site Utilization Review Behavioral Specialist. In this full-time role, you will manage authorization, concurrent review, and re-authorization processes for clients receiving outpatient mental health and substance use disorder treatment.
The ideal candidate possesses a strong working knowledge of the Medicaid managed care system, ensuring seamless operations between clinical documentation, payer guidelines, and continuous client care.
Key Responsibilities
- Authorization Management: Initiate, track, and manage initial and concurrent authorizations, re-authorizations, and retro-reviews for behavioral health services.
- Medicaid & Payer Coordination: Serve as a primary liaison between clinical teams and state/managed care Medicaid payers to secure timely approvals and prevent gaps in client care.
- Clinical Chart Audits: Review client health records and clinical documentation to ensure strict alignment with medical necessity criteria, diagnostic requirements, and state/payer regulations.
- Level of Care Advocacy: Utilize established clinical criteria sets to evaluate client placement and advocate for appropriate levels of behavioral healthcare services.
- Appeals & Peer Reviews: Coordinate and manage clinical peer-to-peer reviews, and draft appeals for denied claims or authorization truncations.
- Cross-Functional Collaboration: Partner closely with multidisciplinary teams, therapists, psychiatrists, and billing staff to resolve discrepancies and support revenue cycle goals.
- Reporting & Tracking: Maintain accurate department tracking systems and report regularly on utilization metrics, authorization statuses, and upcoming deadlines.
Qualifications & Requirements
- Education & Experience:
- Bachelor’s degree in social work, Psychology, Counseling, Health Administration, Business Administration or a related field; OR
- Two (2) to Five (5) years of progressive, hands-on experience working in utilization review, healthcare insurance, or managed care environments within a social service/behavioral health setting.
- Technical Expertise: Comprehensive understanding of the Medicaid system, managed care operations, precertification frameworks, concurrent reviews, and medical necessity guidelines.
- Behavioral Health Knowledge: Familiarity with substance use and mental health terminology, diagnostic codes (DSM-5/ICD-10), and treatment modalities.
- Administrative Skills: Highly organized with exceptional attention to detail, strong time-management skills, and the ability to meet strict deadlines in a fast-paced environment.
- Technology Proficiency: Comfortable operating Electronic Health Records (EHR) systems and Microsoft Office Suite (Word, Excel, Outlook).
Benefits & Perks
- Competitive salary commensurate with experience
- Comprehensive medical, dental, and vision insurance packages
- Paid time off (PTO) and paid holidays
- Retirement plan options
Professional growth and training opportunities within a nationally recognized CCBHC setting
Pay: $55,000.00 - $65,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Parental leave
- Vision insurance
Work Location: In person
Salary : $55,000 - $65,000