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.

• 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

• 3+ years utilization review experience in behavioral health, substance use, detox, residential, or outpatient settings, preferred
• Experience with insurance authorizations and concurrent reviews
• 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