Trilogy Behavioral Health

Authorization and Utilization Review Specialist

Req No.
Regular Full-Time


About Trilogy Behavioral Healthcare:

Trilogy Behavioral Healthcare Inc. strongly believes that treatment services are more effective when provided in the client’s natural setting, hence, the majority of services provided are located in the community.  Trilogy Behavioral Healthcare Inc. also employs a holistic approach to each client’s treatment and integrates all facets of our clients’ lives including mental/emotional health, physical health/wellness, employment and education, social and family relationships, substance use/abuse issues, and housing needs.


Typical services provided include case management, counseling/therapy, individual skills training, medication training, crisis intervention, linkage to community resources, advocacy, assessment, and treatment planning.


The Authorization and Utilization Review Specialist is responsible for providing support to the billing department to decrease authorization denials and maximize Medicaid and MCO claim revenues.



  • Educate clinical staff regarding the services to be provided & the necessary steps to successfully obtain authorization
  • Primary liaison with state and MCO’s in regards to authorizations and UR issues
  • Spearheads the Utilization Review processes at Trilogy; develops policies and procedures in regards to Utilization Review; trains staff on Utilization Review processes
  • Communicate with admin staff,  clinicians, and Clinical Managers/Directors any pertinent information about the clients and or authorizations.
  • Conducts Utilization Review reviews of client charts; reports deficiencies to clinical managers/directors
  • Interact with clinical sources to ensure timely and effective service
  • Review authorization reporting weekly
  • Submit and obtain updates regarding member authorization for service
  • Communicate trends and issues regarding obtaining authorizations to Senior staff and or managers
  • When notified that a patient’s insurance has lapsed, communicates this to clinical staff and follows up with new insurance and authorization information.
  • Perform other duties as assigned


  • MA degree required
  • Licensed Clinical Social Worker, Licensed Clinical Professional Counselor, Licensed Practitioner of the Healing Arts, or Licensed Registered Nurse required
  • Minimum of 2 years experience in healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
  • In depth understanding of Authorization processes with all Medicaid payors
  • Strong Microsoft office skills (Word, Excel, Access, etc)
  • Experience with CareLogic preferred.
  • Highly detail oriented, with strong organizational skills
  • Strong financial analysis skills, analytical mindset, intellectual curiosity
  • Ability to investigate problems and develop/communicate solutions
  • Ability to meet assigned deadlines
  • Excellent communication and interpersonal skills with a focus on customer service
  • Ability to act and operate independently, with minimal supervision


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