About Us
Top of the World Ranch is a premier addiction treatment and mental health facility located on a serene 315-acre ranch. We are dedicated to providing holistic, evidence-based care that helps individuals achieve lasting recovery. Our compassionate, multidisciplinary team values collaboration, professionalism, and excellence in care.
Position Summary
The Utilization Reviewer (UR) is responsible for managing all aspects of utilization management, ensuring that clinical services are delivered in accordance with payer requirements and medically necessary criteria. This role acts as a critical liaison between clinical staff, insurance providers, and clients to ensure continued treatment authorization, accurate documentation, and timely reviews.
Key Responsibilities
- Conduct concurrent and retrospective reviews of clinical documentation to determine medical necessity.
- Submit timely authorization requests and updates to third-party payers (commercial insurance, managed care, etc.).
- Communicate effectively with insurance companies, treatment teams, and leadership regarding authorization status and utilization trends.
- Monitor length of stay and advocate for appropriate continued treatment days.
- Ensure compliance with all payer guidelines, accrediting bodies (Joint Commission), and organizational policies.
- Identify documentation gaps and collaborate with clinical staff to strengthen treatment plan justifications.
- Maintain accurate records of utilization activities, authorization outcomes, and payer communication.
- Provide utilization management reports and metrics to leadership as requested.
Qualifications
- Current RN, LPN, LCSW, LCPC, LMHC, LISW, LPC, or LMSW or equivalent clinical license.
- Experience in behavioral health, addiction treatment, or related healthcare field.
- Knowledge of medical necessity criteria (ASAM, DSM-5, insurance payer standards).
Preferred:
- Prior experience in utilization review, case management, or managed care.
- Familiarity with electronic health records (EHR) and payer portals.
- Excellent communication, negotiation, and documentation skills.
Skills & Competencies
- High attention to detail and organizational skills.
- Ability to manage multiple authorizations and deadlines.
- Collaborative approach with both clinical and administrative staff.
- Advocacy skills to support clients’ continued access to care.
Why Join Top of the World Ranch?
- Work in a unique, holistic recovery environment on a beautiful ranch setting.
- Be part of a compassionate, mission-driven team.
- Competitive salary and benefits package.
- Opportunities for professional development and growth.
Job Type: Full-time
Pay: $22.97 - $27.66 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Travel reimbursement
- Tuition reimbursement
- Vision insurance
Work Location: Hybrid remote in Milan, IL 61264
