UtilizationReviewSpecialist

Lighthouse Behavioral Health Solutions (LBHS) offers a full continuum of care, including outpatient, intensive outpatient, partial hospitalization, residential treatment, psychiatric services, and medication‑assisted treatment. We take pride in creating a welcoming, compassionate environment where individuals feel supported. Our team believes in every client’s ability to achieve recovery and rebuild meaningful, engaged lives in their communities. Position: Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical criteria for admission, continued stay, and discharge. This role supports compliance with payer requirements, maintains proper documentation, and collaborates with clinical and administrative teams to maximize reimbursement while ensuring high-quality, medically necessary care. Reports to: VP of Revenue Cycle Management Duties and Responsibilities: Duties include, but are not limited to: Conduct initial and concurrent reviews to determine medical necessity using established criteria Submit authorization requests and clinical documentation to insurance providers in a timely manner Monitor authorizations and ensure services rendered align with approved levels of care Track and manage authorization expirations and initiate reauthorization requests as needed Review clinical records for completeness, accuracy, and compliance with payer and regulatory standards Ensure treatment plans, progress notes, and discharge summaries support medical necessity Provide feedback to clinical staff to improve documentation quality Maintain adherence to HIPAA and confidentiality regulations Serve as the primary liaison between the organization and insurance companies for utilization review matters Participate in peer-to-peer reviews when required Address denials by gathering supporting documentation and submitting appeals Stay current with paye