Utilization Review Specialist

Utilization Review Specialist (Remote | M–F | $45K–$65K)

Make an impact. Grow your career.

At Nova Recovery Center, we believe in providing more than treatment — we create hope and lasting recovery. As a Utilization Review Specialist, you’ll play a pivotal role in ensuring our clients receive the care they need while advocating for high-quality, cost-effective solutions. If you’re passionate about helping others, thrive in a collaborative environment, and want a career where your expertise truly makes a difference, we’d love to meet you.

What You’ll Do

• Lead pre-certification, prior approvals, concurrent and retrospective reviews, ensuring timely, accurate decisions.
• Determine medical necessity and appropriateness of services using established clinical criteria.
• Act as a client advocate, expediting care and collaborating with physicians, admissions, clinical, and billing teams.
• Partner with the Medical Director and leadership to identify quality issues, compliance risks, and opportunities for improvement.
• Play an active role in discharge planning and care coordination, helping clients transition successfully.
• Stay ahead of industry standards by continuing education in ASAM criteria, managed care requirements, case management, and compliance.
• Collaborate across departments to improve policies, streamline processes, and strengthen compliance.

What We’re Looking For

• Education: Bachelor’s degree in Social Work, Mental Health, or related field OR licensed RN in Texas (current & unrestricted).
• Experience: 3–5 years working with external review organizations, UR/UM processes, or direct clinical experience in psychiatric/mental health settings.
• Knowledge: Familiarity with Texas DSHS LOC Guidelines, TDI Criteria, ASAM Criteria, and Joint Commission standards.
• Skills: Exceptional communication, detail-oriented documentation, strong computer proficiency, and a self-starter mindset.

Position Details

• Schedule: Monday–Friday, flexible hours between 7 AM – 5 PM.
• Remote: Work-from-home opportunity if you live in Arkansas, Ohio or Texas
• Salary: $45,000 – $65,000, based on experience.

Why Join Nova Recovery?

We know great work deserves great support. That’s why we offer a comprehensive benefits package designed to support your well-being and work-life balance:

• Medical Insurance through Blue Cross Blue Shield (BCBS)
• Health Savings Account (HSA)
• Dental, Vision, and Life Insurance options available
• Paid Time Off (PTO) – accrue 5.85 hours per pay period after probationary period
• Work-life balance with remote flexibility and weekday hours

Ready to make a difference while growing your career? Apply today and join Nova Recovery Center in creating lasting recovery and hope for our clients.