Blue Cross Rn Remote Jobs in Boca Raton, FL (NOW HIRING)

Utilization Review Specialist | Remote | Full-Time
$50,000 – $65,000 Annually | Weekdays (Weekend Availability as Needed)

Banyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist to join our corporate team. In this remote role, you'll manage a caseload of 50–75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a key liaison between Banyan's clinical operations and the managed care organizations that fund patient treatment. Your work directly protects patient access to care and keeps the business running.

This is a high-volume, relationship-driven role for someone who thrives on precision, knows how to navigate managed care, and understands the stakes on both sides of the authorization process.

About Banyan Treatment Centers

Banyan Treatment Centers is a leading national provider of intensive treatment for individuals facing substance use and mental health disorders. Backed by TPG, one of the nation’s largest private equity investors, Banyan is rapidly expanding access to high-quality, compassionate care.

Why Join Our Team?

• Mission-driven work with real business impact — your authorizations directly determine whether patients stay in treatment. Few roles sit closer to the intersection of clinical care and organizational sustainability.
• Nationally recognized organization — Joint Commission–accredited, with 18 locations and telehealth services nationwide, and the infrastructure to support your work at scale.
• Remote flexibility — work from anywhere while collaborating with clinical, billing, and operations teams across the country.
• Collaborative environment — partner closely with clinical, operational, and billing teams to resolve outstanding case issues, support discharge planning, and ensure timely reimbursement.
• Room to grow — join a rapidly expanding organization where UR professionals have visibility across the enterprise and opportunities to advance.
• Comprehensive benefits including medical, dental, and vision insurance; whole and term life insurance; short- and long-term disability; 401(k) with employer match; paid time off and holidays; wellness incentives; and employee assistance and referral programs.

Key Responsibilities

• Manage a caseload of 50–75 patients, authorizing 15–25 cases daily and ensuring timely utilization reviews and appropriate level of care determinations
• Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards
• Verify insurance benefits, coordinate authorizations, and communicate effectively with external case managers and managed care organizations
• Establish and maintain contracts with managed care companies and request rate increases when appropriate
• Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement
• Identify and address over- and underutilization trends
• Assist in resolving outstanding case issues with insurers

Qualifications

Required:

• High school diploma or equivalent
• Minimum one year of utilization review experience in a psychiatric or chemical dependency setting
• Strong organizational, documentation, and communication skills
• Ability to manage high caseloads with accuracy and efficiency
• Comfortable working independently in a remote environment

Preferred:

• Graduate degree in a health or behavioral health related field
• Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) — valued but not required
• Experience working with managed care organizations, insurance authorization, and level of care criteria
• Familiarity with Joint Commission standards and behavioral health regulatory requirements

Apply Now

If you're experienced in utilization review, thrive in a fast-paced and high-volume environment, and want your work to matter beyond the spreadsheet, we'd like to meet you. Apply today to join the Banyan Treatment Centers corporate team.

Banyan Treatment Centers is an equal opportunity employer.