Utilization Review Trainee

Department: Utilization Review
Location: On-Site
Job Type: Full-Time

About the Role

We are seeking a motivated and detail-oriented Utilization Review Trainee to join our team. This is a great opportunity for someone with behavioral health or healthcare experience who is interested in developing a career in Utilization Review.

In this role, you will receive hands-on training in the utilization review process, including clinical criteria, payer requirements, electronic medical record (EMR) systems, and authorization procedures. You will work closely with experienced Utilization Review team members while building the skills needed to independently manage authorization reviews.

This position serves as a developmental pathway to a Utilization Review Specialist role.

What You'll Do

• Learn and navigate EMR systems used by assigned facilities.
• Review and document clinical information required for authorization submissions.
• Develop a working knowledge of ASAM and LOCUS criteria.
• Learn to apply clinical guidelines to determine appropriate levels of care.
• Become familiar with payer-specific authorization requirements.
• Communicate professionally with insurance companies regarding authorizations.
• Assist with timely and accurate authorization submissions and follow-ups.
• Escalate authorization issues or denials to senior Utilization Review staff when appropriate.
• Maintain accurate documentation while following HIPAA and company confidentiality requirements.

Qualifications

• Associate's or Bachelor's degree in Nursing, Social Work, Psychology, or a related field, or equivalent experience.
• Minimum of one year of experience in behavioral health, case management, utilization review support, patient advocacy, or a related healthcare environment.
• RN, LCSW, LMFT, or other clinical licensure is preferred but not required.
• Familiarity with medical terminology and healthcare documentation.
• Knowledge of ASAM, LOCUS, clinical guidelines, or healthcare regulations is a plus.

What We're Looking For

The ideal candidate is someone who is eager to learn and grow within Utilization Review and demonstrates:

• Strong written and verbal communication skills
• Critical thinking and problem-solving abilities
• Excellent attention to detail
• Strong organizational and time-management skills
• Reliability and accountability
• Active listening and collaboration skills
• Ability to learn new systems and processes
• Professionalism when communicating with insurance companies and healthcare partners

What Success Looks Like

Success in this role will be measured by your progress throughout the training program, including authorization accuracy, completion of training and competency milestones, and timely completion of assigned reviews and follow-ups.

Work Environment

This is an on-site position in an office environment. The role requires prolonged computer use and frequent interaction with electronic medical record systems and insurance portals.

Because this position involves access to protected health information (PHI), employees are expected to maintain strict compliance with HIPAA regulations and company confidentiality policies.

Pay: $28.00 - $30.00 per hour

Expected hours: 40.0 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person