Utilization Review Specialist

Ambrosia Behavioral Health is revolutionizing behavioral, substance use, and eating disorder treatment for adolescents and adults by combining cutting edge neuroscience and precision diagnostics with compassionate, evidence-based therapies. Guided by our core values—Compassion, Excellence, and Innovation—we provide individualized, holistic, trauma-informed care in a supportive and healing environment that improves patient outcomes and empowers patients toward long-term recovery.

Position Summary

The Utilization Review Specialist is responsible for managing all aspects of insurance authorization and concurrent review for assigned patients. This role ensures appropriate level of care determinations, maximizes reimbursement, and supports clinical teams in maintaining medical necessity and compliance with payer requirements.

The ideal candidate is detail-oriented, clinically knowledgeable in behavioral health, and experienced in communicating effectively with insurance providers and multidisciplinary teams.

• This position is on site in West Palm Beach or Port St Lucie

Key Responsibilities

• Obtain and manage initial and concurrent insurance authorizations
• Conduct peer-to-peer reviews as needed
• Review clinical documentation to ensure alignment with ASAM and payer guidelines
• Track authorized days and follow up on expiring authorizations
• Assist with denials and appeals
• Maintain detailed documentation of payer communications in Kipu
• Collaborate with clinical, admissions, and billing teams

Qualifications

• 3+ years utilization review experience in behavioral health, substance use, detox, residential, or outpatient settings, required

• Experience with insurance authorizations and concurrent reviews

• Adolescent experience preferred

• Strong understanding of ASAM criteria and medical necessity standards

• Excellent written and verbal communication skills

• Strong critical thinking and clinical assessment skills

• Experience in a multi-level behavioral health and substance use facility

• Knowledge of Kipu

• Ability to pass a level 2 background check: HB531 | Florida Agency for Health Care Administration

What We Offer

• Competitive salary
• Health benefits with no co-pay or deductible
• Dental and vision benefits
• PTO and paid holidays
• 401(k) with company match
• Supportive team culture