What are the responsibilities and job description for the Utilization Specialist position at Sierra Tucson?
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https://www.acadiacareers.com/us/en/job/100121/Utilization-Specialist
Company Description Sierra Tucson is a nationally recognized behavioral health treatment center that has provided compassionate, evidence-based care for more than 30 years. The multidisciplinary team focuses on clinical excellence in treating adults with addiction, PTSD, mood disorders, and other complex behavioral health conditions. Recommended by doctors and therapists worldwide, Sierra Tucson is known for creating safe, structured environments that support meaningful recovery. Since 1983, its programs have positively impacted the lives of over 27,000 patients and more than 70,000 family members. Team members join a mission-driven organization committed to holistic healing and long-term change.
Role Description The Utilization Specialist is a full-time, on-site role based in Tucson, AZ, responsible for supporting appropriate and timely access to care through effective utilization review and management processes. Day-to-day responsibilities include reviewing clinical documentation to determine medical necessity, preparing and submitting authorization requests to payers, and coordinating concurrent reviews and extensions of care. The role involves collaborating closely with clinical teams and case managers to ensure documentation meets payer requirements, tracking authorizations and denials, and updating internal systems with accurate benefit and approval information. The Utilization Specialist communicates with insurance companies regarding benefits, coverage, and appeals, provides clear information to patients and families about utilization-related matters, and supports continuous improvement in utilization processes and payer relationships.
Qualifications
- Candidates should possess strong clinical documentation review and utilization management skills, including the ability to interpret medical necessity criteria and payer guidelines.
- Candidates should possess skills in insurance verification, authorization processing, and claims-related follow-up in a behavioral health or healthcare setting.
- Candidates should possess effective communication and collaboration skills for working with multidisciplinary clinical teams, payers, patients, and families.
- Candidates should possess organizational, time-management, and detail-oriented skills to manage multiple cases, deadlines, and documentation requirements.
- Candidates should possess proficiency with electronic health record (EHR) systems, basic data entry, and common office software (e.g., email, spreadsheets, databases).
- Relevant experience in behavioral health, addiction treatment, or related healthcare utilization review is preferred.
- Knowledge of managed care principles, insurance terminology, and state/federal regulations related to behavioral health services is beneficial.
- A master's or bachelor’s degree in a health-related field, social services, or a similar discipline is preferred; equivalent experience may be considered.