Utilization Review Analyst Manager

At Strive Recovery, we are committed to transforming lives through compassionate, evidence-based behavioral health and addiction services. As we grow, we are seeking dedicated professionals who are ready to elevate care and make a difference every day.

Position Summary

The UR Analyst is responsible for reviewing clinical documentation to ensure medical necessity, appropriateness of care, and compliance with payer requirements. This role supports the facility’s mission by maximizing reimbursement and maintaining high standards of care for individuals undergoing addiction services and behavioral health treatment. Experience building or significantly improving a UR department. 

Job Descriptions

• Conduct initial and concurrent reviews for all levels of care: Detox, Residential, PHP, IOP, and Outpatient.
• Verify Medicaid/MCO eligibility and benefits before admission.
• Submit initial authorizations for 3.5, 3.1 or 2.5 level of care.
• Peer to Peer and appeal experience
• Collaborate with clinical and medical teams to support documentation for payor compliance.
• Monitor and track authorization status, denials, appeals and stay reviews timely.
• Closely work with Accounts Receivables department to ensure accurate records and manage requests in payer portals.
• Assist with audits and ensure compliance with state, federal, and accreditation standards.
• Prepare and support NPs for peer-to-peer reviews (complete template for NP).
• Maintain census tracker, auth dates and review due dates.
• Generate weekly utilization and denial reports.
• Knowledge of ASAM critera 
• Follow up on denials with understanding and to make sure those are appealed timely.
• Communicate with insurance case managers and advocate for client care needs
• Coordinate discharge/step-down coverage and aftercare
• Other duties necessitated by the respective facility

Benefits

• Competitive Salary
• Medical, Dental and Vision plan
• Vacation plan
• Paid Time Off
• Tuition Reimbursement
• Positive work environment
• Regular staff Appreciation and Recognition

Qualifications

• Bachelor’s degree in nursing, Social Work, Psychology, or related field (RN or LCSW preferred).
• Minimum 5 years of experience in utilization review, preferably in addiction treatment or behavioral health.
• Knowledge of insurance authorization processes.
• Strong communication, organizational, and documentation skills.
• Prior leadership experience

We are an equal opportunity/affirmative action employer. All qualified applicants are encouraged to apply and will receive consideration for all employees; free from discrimination on the basis of race, creed, color, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, religion, associational preferences, status as a qualified individual with a disability, or status as a protected veteran.