UR Analyst

The UR Analyst is responsible for reviewing clinical documentation to ensure medical necessity, appropriateness of care, and compliance with payer requirements. This role supports the facility’s mission by maximizing reimbursement and maintaining high standards of care for individuals undergoing addiction services and behavioral health treatment.

• Conduct initial and concurrent reviews for all levels of care:
  Detox, Residential, PHP, IOP, and Outpatient.
• Verify Medicaid/MCO eligibility and benefits before admission.
• Submit initial authorizations for 3.5or 2.5 level of care.
• Collaborate with clinical and medical teams documentation for payor compliance.
• Monitor and track authorization status, denials, appeals and stay reviews.
• Maintain accurate records and manage requests in payer portals.
• Assist with audits and ensure compliance with state, federal, and accreditation standards.
• Prepare and support NPs for peer-to-peer reviews (complete template for NP).
• Maintain census tracker, auth dates and review due dates.
• Generate weekly utilization and denial reports.
• Communicate with insurance case managers and advocate for client care needs.
• Coordinate discharge/step-down coverage and aftercare.

• Medical, Dental and Vision plan
• Tuition Reimbursement
• Positive work environment
• Regular staff Appreciation and Recognition

• Bachelor’s degree in Nursing, Social Work, Psychology, or related field (RN or LCSW preferred).