What are the responsibilities and job description for the Utilization Review Specialist position at Genesis Recovery and Wellness of Ohio?
Utilization Review Specialist — Prior Authorizations & Appeals
Genesis Recovery and Wellness of Ohio Location: Fairlawn / Middleburg Heights, OH
Job Type: Full-Time
About Us
Genesis Recovery and Wellness of Ohio is a community behavioral health outpatient program dedicated to providing accessible, high-quality care to individuals in our community. We are seeking a detail-oriented Utilization Review Specialist to join our administrative team and help ensure our clients receive uninterrupted access to the care they need.
Position Summary
The Utilization Review Specialist is responsible for managing the full prior authorization lifecycle for Ohio Medicaid, including submissions, denial appeals, peer-to-peer reviews, and ongoing tracking and follow-up. This role is critical to minimizing care disruptions for clients and ensuring timely reimbursement for services rendered.
Key Responsibilities
- Submit and manage prior authorization requests to Ohio Medicaid and associated managed care plans
- Monitor authorization status and proactively follow up to prevent lapses in coverage
- Prepare and submit denial appeals, including gathering clinical documentation to support medical necessity
- Coordinate, schedule and perform, when needed, peer-to-peer reviews with payer medical reviewers and treating providers.
- Track authorization expiration dates and initiate timely re-authorization requests
- Maintain accurate, organized records of all authorizations, denials, appeals, and outcomes
- Communicate authorization status updates to clinical and billing staff
- Identify patterns in denials and flag recurring issues to leadership
- Stay current on Ohio Medicaid utilization review policies, criteria, and procedural requirements
Qualifications
- Prior experience with utilization review, prior authorizations, or insurance/managed care processes required
- Familiarity with Ohio Medicaid and/or behavioral health managed care plans strongly preferred
- Experience with denial appeals and peer-to-peer review coordination
- Strong organizational skills with the ability to track multiple authorizations and deadlines simultaneously
- Excellent written and verbal communication skills
- Working knowledge of behavioral health/substance use treatment terminology a plus
- Proficiency with EHR systems and payer portals
- Associate's or Bachelor's degree in a healthcare-related field preferred, or equivalent relevant experience
Pay: $22.50 - $31.00 per hour
Expected hours: 40.0 per week
Benefits:
- Dental insurance
- Employee assistance program
- Flexible schedule
- Paid time off
- Professional development assistance
People with a criminal record are encouraged to apply
Experience:
- Utilization review: 2 years (Required)
License/Certification:
- LSW (Preferred)
- LPCC (Preferred)
Ability to Commute:
- Fairlawn, OH 44333 (Preferred)
Work Location: In person
Salary : $23 - $31