Live In Cigna Utilization Review Nurse Jobs in Boca Raton, FL

Quadrant Billing Solutions delivers hands-on, process-driven operational support to behavioral health programs.

We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL

Compensation: $55,000 - $70,000 a year - (Based on experience) Full-time

Why Join Quadrant Health Group?

• Competitive salary commensurate with experience.
• Comprehensive benefits package, including medical, dental, and vision insurance.
• Paid time off, sick time and holidays.
• Opportunities for professional development and growth.
• A supportive and collaborative work environment.
• A chance to make a meaningful impact on the lives of our clients.

Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions, a proud member of the Quadrant Health Group, is expanding and seeking to add a Utilization Review Specialist to our growing team. We offer boutique medical billing specifically for substance abuse and mental health treatment. The ideal candidate will have 3+ years of clinical experience and a strong desire to contribute to a dynamic, fast-paced & results driven environment. We're looking for motivated, eager individuals who are excited about the opportunity to learn and grow within the company.

This role is for someone ready to learn a structured system: timely payer outreach, clean documentation, consistent follow-up, and strong coordination with clinical teams. You will be trained, coached, and expected to execute with reliability. If you dislike structure, deadlines, or detailed documentation, this role isn’t for you.

What You'll Do:

The UR Specialist plays a critical role in ensuring both clinical quality management and financial viability for our partner facilities. This position is not just about securing authorizations—it’s about bridging the gap between clinical care and revenue cycle management. UR Specialists serve as the direct liaison between facility clinical teams, insurance providers, and the billing department, ensuring seamless communication, accurate documentation, and optimal patient outcomes.

This is an in-office position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be considered.
Key Responsibilities

Clinical Advocacy

Facility Collaboration & Clinical Quality Management

• Work closely with clinical teams to ensure treatment plans align with insurance criteria for continued authorization.
• Provide ongoing feedback to facilities regarding documentation improvements, level of care justifications, and payer trends.
• Serve as the primary point of contact between facilities and the billing team, ensuring smooth coordination and timely approvals.
• Proactively educate and guide facilities on insurance requirements, helping them adapt to payer expectations.

Communication & Case Management

• Maintain clear, professional, and proactive communication with facility staff, insurance representatives, and internal billing teams.
• Manage a caseload of 50-70 patients, ensuring timely follow-ups, thorough documentation, and strong attention to detail.
• Document all interactions in the EMR (Kipu experience required) and ensure all authorization trackers are up to date.
• Ensure that denied or pended cases are escalated appropriately through peer reviews or appeals.

Operational Excellence & Technology Utilization

• Efficiently navigate EMR systems (Kipu experience required)
• Utilize Google Docs, Google Sheets, and Google Drive for internal reporting, tracking, and collaboration.
• Assist in after-hours utilization reviews as needed to prevent service disruptions and maintain compliance.
• Adapt quickly to payer policy changes and ensure facilities are informed of updates that impact clinical documentation and authorization processes.

What We’re Looking For

• Ability to be aggressive in advocating on behalf of our facilities to insurance carries
• Ability to communicate effectively with clinical team to understand treatment needs of patients
• Understanding of their role in a multi-disciplinary team
• Ability to provide detailed feedback and Clinical Quality management to all assigned facilities
• Always communicate in a professional manner in both verbal and written communication internally and with our facility’s
• Being focused throughout the day while staying organized and maintaining attention to detail
• Able to manage a minimum caseload of between 30-50 patients
• Strong working knowledge of ASAM & LOCUS criteria
• Work collaboratively with insurance providers
• Be proficient with using various EMR software (must have experience with Kipu)
• Exceptional customer service and both verbal and written communications skills
• Ability to grow and foster relationships with care managers as well as clinicians at the facilities
• Track authorization start/end dates to prevent lapses in coverage
• Document payer interactions, reference numbers, and determinations clearly
• Coordinate with clinical staff and admissions teams to ensure payer needs are met quickly
• Follow established UR workflows and receive ongoing training and coaching
• Support continuous improvement through accuracy and consistent execution
• Must be a team player and be willing to multitask
• Must be available to handle reviews after standard business hours as needed
• Attention to detail and must be organized
• Must be proficient in Google docs, Google word, and utilizing Google drive
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Education Requirements:

• High School Diploma or equivalent
• Bachelors degree preferred
• Minimum 2 year experience in utilization review
• Minimum 4 years of experience in substance abuse or mental health treatment

Character Traits

• Highly coachable learner: Absorbs training quickly and improves through feedback
• Organized and deadline-aware: Tracks authorization timelines carefully and prevents coverage gaps
• Detail-oriented documenter: Records authorization outcomes accurately and consistently
• Reliable team supporter: Executes assigned workflows with consistency and accountability

Who This Role Is NOT For

● People who dislike repetitive follow-up work

● Anyone uncomfortable with detailed documentation

● People who want unstructured or low-accountability roles

About Quadrant Billing Solutions:

At Quadrant Billing solutions, we believe in fostering a culture of compassion, innovation, and excellence. We are dedicated to empowering individuals to achieve their optimal health and well-being. Our team is comprised of highly skilled professionals who are passionate about making a difference in the lives of those we serve. Join us and be part of a team that values your contributions and supports your professional growth.

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