Utilization Review Specialist

Job overview

Utilization Review Specialist is an onsite role in Middletown, NY; pay is $27–$34 per hour. RECAP operates OASAS-certified substance use disorder treatment programs, and this position supports utilization management and clinical documentation review across its residential reintegration and outpatient rehabilitation programs.

What you'll do

• Obtain and track service authorizations
• complete concurrent and continued-stay reviews
• submit medical-necessity documentation
• coordinate peer-to-peer reviews and appeals
• review clinical records for completeness, compliance, and level-of-care support
• collaborate with billing staff on authorization and reimbursement issues
• conduct chart audits, support quality improvement, and communicate payer requirements to clinical and administrative teams.

What we're looking for

Skills & competencies

utilization review

behavioral health

substance use disorder

clinical documentation

medical necessity

authorizations

medicaid managed care

oasas

middletown ny

recap

$27–$34/hr

quality improvement

Work arrangement

• Weekend coverage required

Why this role

Requires a bachelor’s degree in a related field, an eligible professional credential, at least three years of behavioral health or substance use disorder treatment experience, and knowledge of ASAM Criteria. Travel between RECAP locations is required as needed.

About the employer

Regional Economic Community Action Program, Inc is hiring for this role. Industry: Other Individual and Family Services. Sector: 62.