{"schemaVersion":"jobsearcher.job.v1","id":"3cc2f9811c083bf7db4e8a7c","url":"https://jobsearcher.com/jobs/3cc2f9811c083bf7db4e8a7c","canonicalUrl":"https://jobsearcher.com/jobs/3cc2f9811c083bf7db4e8a7c","title":"Utilization Review Specialist","description":"General Description\n\nThe Utilization Review Specialist processes all insurance authorizations for partial hospitalization programs, intensive outpatient programs and outpatient programs across business entities to ensure timely and appropriate services for clientele.\n\nTasks & Responsibilities\n\nA. Essential Duties\n\nHandle the continuum of the utilization process for all ABHS entities.\nOutreach to insurance companies to gain authorizations for services such as TMS, partial hospitalization, intensive outpatient and outpatient programming.\nMaintain ongoing communication with the Patient Access Center, Billing Department, Clinical Department and Medical Department.\nEvaluate and assure adequacy of clinical information to screen for medical necessity\nConsultation with internal Clinical and Medical staff regarding alternate services and clinical criteria\nAdminister appeal process for denials\n\nB. Additional Duties\n\nAssists and covers other staff when necessary to maintain high productivity and efficiency in the department.\nAs the company continues to grow, additional responsibilities that are essential for the department to be successful will be assigned accordingly.\n\nC. Interpersonal Relations\n\nCreate Meaningful Connections: Demonstrates ability to function effectively as a part of team. Uses outstanding oral and written communication with employees at all levels of the business for support and sharing of information.\nTake Accountability: Take constructive feedback and prevent discourse among our peers.\nLive in the Solution: Critically thinking should be the solution when problems arise. Having the ability to accept constructive criticism well in an open and non-defensive manner.\nBe Professional: Wear business casual attire (please see dress code policy).\n\nCompetencies\n\nAdaptability\nCustomer Service\nDecision Making\nDependability\nEthics\nInterpersonal Skills\nJob Knowledge\nConflict Management\nOrganization Skills\nProductivity\nSelf-Development\nTeamwork\n\nPerformance Standards & Measurement\n\nCompliance with essential and incidental duties; compliance with company policies and procedures.\nCompliance with state and federal laws and regulations applicable to the business.\n\nEquipment, Tools & Machines\n\nUse of computer, telephone, and other office equipment such as a printer and fax.\nUse of company network and email domain.\n\nWorking Conditions\n\nAir conditioned and well-illuminated office environment and outdoor environment.\nMay have several responsibilities at once. Interaction with others is constant and can be interruptive.\nWork may be stressful at times due to high level workflow.\nAvailability to work flexible hours including weekends, holidays, and evenings as is required to comply with the purpose of the job and accommodate client needs.\nParticipates in educational training, orientations, or compliance programs as needed to maintain competency.\nIf you must leave your employment with our company, we request employees to give us at least 14 days resignation notice in writing.\n\nDemands\n\nEnthusiastic self-starter operating with sustained energy and showing great initiative.\nComfort working with a diverse base of support, including members, employers, providers, colleagues, community leaders, volunteers, non-profit organizations, vendors, etc.\nExcellent interpersonal and communication skills, including ability to read, write, spell in English legibly and without excessive grammatical or communication errors.\nTalk and hear both by person and by telephone; ability to speak clearly and effectively using proper grammar before patients, employees and business partners, among others.\nExcellent organizational skills.\nAccepts constructive criticism well in an open and non-defensive manner.\nAbility to manage conflicting priorities. Ability to maintain a positive work ethic and a congenial attitude in the face of a high-pressure environment.\nAbility to function independently and with flexibility.\nAbility to work under pressure, handle multiple tasks and interruptions.\nOccasional lifting of moderately heavy office supplies; ability to lift supplies for community events, trade shows, conferences, and other marketing opportunities applicable to the organization; ability to lift, push or pull up to 25lbs.\nAbility to sit, stand, or walk for extended periods of time.\nExcellent presentation, negotiation and relationship-building skills required.\nMust have strong computer skills to meet Microsoft Office and Electronic Health Record software requirements.\n\nQualifications\n\nEducation:\n\nHigh School Diploma or equivalent education required\n\nExperience:\n\nAt least 1 year of Utilization Review experience\nExperience working in an electronic medical records system.\nComputer literate: Microsoft Office (Excel, Word, and PowerPoint) required.","company":"Abhs","rawCompany":"abhs","city":"Evesham Twp","state":"NJ","isRemote":false,"isActive":false,"createdAt":"2026-08-27T12:47:40.826Z","occupations":[{"code":"43-6013.00","title":"Medical Secretaries and Administrative Assistants","slug":"medical-secretaries-and-administrative-assistants"},{"code":"29-2099.08","title":"Patient Representatives","slug":"patient-representatives"},{"code":"29-2072.00","title":"Medical Records Specialists","slug":"medical-records-specialists"}],"industries":[{"code":"621498","title":"All Other Outpatient Care Centers","slug":"all-other-outpatient-care-centers"},{"code":"621420","title":"Outpatient Mental Health and Substance Abuse Centers","slug":"outpatient-mental-health-and-substance-abuse-centers"},{"code":"621999","title":"All Other Miscellaneous Ambulatory Health Care Services","slug":"all-other-miscellaneous-ambulatory-health-care-services"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Utilization Review Specialist","description":"General Description\n\nThe Utilization Review Specialist processes all insurance authorizations for partial hospitalization programs, intensive outpatient programs and outpatient programs across business entities to ensure timely and appropriate services for clientele.\n\nTasks & Responsibilities\n\nA. Essential Duties\n\nHandle the continuum of the utilization process for all ABHS entities.\nOutreach to insurance companies to gain authorizations for services such as TMS, partial hospitalization, intensive outpatient and outpatient programming.\nMaintain ongoing communication with the Patient Access Center, Billing Department, Clinical Department and Medical Department.\nEvaluate and assure adequacy of clinical information to screen for medical necessity\nConsultation with internal Clinical and Medical staff regarding alternate services and clinical criteria\nAdminister appeal process for denials\n\nB. Additional Duties\n\nAssists and covers other staff when necessary to maintain high productivity and efficiency in the department.\nAs the company continues to grow, additional responsibilities that are essential for the department to be successful will be assigned accordingly.\n\nC. Interpersonal Relations\n\nCreate Meaningful Connections: Demonstrates ability to function effectively as a part of team. Uses outstanding oral and written communication with employees at all levels of the business for support and sharing of information.\nTake Accountability: Take constructive feedback and prevent discourse among our peers.\nLive in the Solution: Critically thinking should be the solution when problems arise. Having the ability to accept constructive criticism well in an open and non-defensive manner.\nBe Professional: Wear business casual attire (please see dress code policy).\n\nCompetencies\n\nAdaptability\nCustomer Service\nDecision Making\nDependability\nEthics\nInterpersonal Skills\nJob Knowledge\nConflict Management\nOrganization Skills\nProductivity\nSelf-Development\nTeamwork\n\nPerformance Standards & Measurement\n\nCompliance with essential and incidental duties; compliance with company policies and procedures.\nCompliance with state and federal laws and regulations applicable to the business.\n\nEquipment, Tools & Machines\n\nUse of computer, telephone, and other office equipment such as a printer and fax.\nUse of company network and email domain.\n\nWorking Conditions\n\nAir conditioned and well-illuminated office environment and outdoor environment.\nMay have several responsibilities at once. Interaction with others is constant and can be interruptive.\nWork may be stressful at times due to high level workflow.\nAvailability to work flexible hours including weekends, holidays, and evenings as is required to comply with the purpose of the job and accommodate client needs.\nParticipates in educational training, orientations, or compliance programs as needed to maintain competency.\nIf you must leave your employment with our company, we request employees to give us at least 14 days resignation notice in writing.\n\nDemands\n\nEnthusiastic self-starter operating with sustained energy and showing great initiative.\nComfort working with a diverse base of support, including members, employers, providers, colleagues, community leaders, volunteers, non-profit organizations, vendors, etc.\nExcellent interpersonal and communication skills, including ability to read, write, spell in English legibly and without excessive grammatical or communication errors.\nTalk and hear both by person and by telephone; ability to speak clearly and effectively using proper grammar before patients, employees and business partners, among others.\nExcellent organizational skills.\nAccepts constructive criticism well in an open and non-defensive manner.\nAbility to manage conflicting priorities. Ability to maintain a positive work ethic and a congenial attitude in the face of a high-pressure environment.\nAbility to function independently and with flexibility.\nAbility to work under pressure, handle multiple tasks and interruptions.\nOccasional lifting of moderately heavy office supplies; ability to lift supplies for community events, trade shows, conferences, and other marketing opportunities applicable to the organization; ability to lift, push or pull up to 25lbs.\nAbility to sit, stand, or walk for extended periods of time.\nExcellent presentation, negotiation and relationship-building skills required.\nMust have strong computer skills to meet Microsoft Office and Electronic Health Record software requirements.\n\nQualifications\n\nEducation:\n\nHigh School Diploma or equivalent education required\n\nExperience:\n\nAt least 1 year of Utilization Review experience\nExperience working in an electronic medical records system.\nComputer literate: Microsoft Office (Excel, Word, and PowerPoint) required.","datePosted":"2026-08-27T12:47:40.826Z","dateModified":"2026-08-27T12:47:40.826Z","hiringOrganization":{"@type":"Organization","name":"Abhs","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Evesham Twp","addressRegion":"NJ","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"3cc2f9811c083bf7db4e8a7c"},"url":"https://jobsearcher.com/jobs/3cc2f9811c083bf7db4e8a7c"}}