What are the responsibilities and job description for the Utilization Specialist position at OneQuest Health?
Utilization Specialist
Location:
Devou Park
Department: Billing Services
Position Reports to:
Director of Billing Services
Position Supervises:
n/a
Profile Last Updated:
December 5, 2025
QUALIFICATIONS
- Minimum of 1 year experience as an authorization/utilization review specialist
- Familiarity with behavioral health authorizations.
- Experience with CareLogic electronic health record system preferred.
- Experience with billing is preferred.
- Demonstrated history of successfully building relationships with insurance companies, their representatives, and case managers.
- Demonstrated history of receiving approval for optimal days at the highest and most appropriate level of care.
- Self-motivated and able to prioritize and identify processes that need to be implemented and/or improved, and tasks that need completion.
- Above-average organizational and time management skills, with great attention to detail.
- Strong verbal and written communication skills.
- Demonstrated proven sensitivity to the various cultural and socioeconomic characteristics of the OneQuest Health clients and staff.
- Valid drivers’ license or other ability to travel between OneQuest Health sites in a timely manner required.
POSITION SUMMARY
The Utilization Specialist is responsible for the authorization and utilization management of assigned service lines for OneQuest Health Residential and OneQuest Health Outpatient. Responsibilities include uploading appropriate documentation into the CareLogic EHR system, running authorization due reports, and managing the extension of upcoming authorizations, working with OneQuest Health staff and management for timely completion of documentation, and contacting insurance companies when necessary.
ESSENTIAL JOB FUNCTIONS
- Complete prior authorization required by the insurance company prior to admission, entering authorization into CareLogic and scanning documentation into CareLogic.
- Perform as a subject matter expert in reading, understanding, interpreting VOBs (verification of benefits) to advise the team on policies that will not pay enough to cover the daily operation cost per patient.
- Track all concurrent reviews to ensure proper documentation is present to advocate for the client to receive the number of days at the highest level of care/most appropriate level of care.
- Provide back up in absence of insurance verification specialist to verify benefits and eligibility for residential services.
- Participate in agency Performance Quality Improvement and Quality Assurance Committee activities.
- Must be able to perform the essential functions of this position with or without reasonable accommodation.
- Attend training as required.
- Other assigned duties.
Salary : $21 - $23