QA Specialist / Utilization Review Liaison

Quality Assurance Specialist / Utilization Review Liaison Make an Impact on Clinical Excellence and Patient Outcomes Avenues Recovery Center is seeking a detail-oriented and proactive Quality Assurance Specialist / Utilization Review Liaison to support clinical operations, documentation compliance, and utilization review processes. This role serves as a critical bridge between treatment teams, facility leadership, and the Utilization Review department, helping ensure high-quality care, regulatory compliance, and positive patient outcomes. The ideal candidate is highly organized, thrives in a fast-paced environment, and is passionate about maintaining clinical excellence while supporting individuals on their recovery journey.

• What You'll Do Quality Assurance & Compliance Conduct regular chart audits to ensure documentation accuracy, completeness, and compliance with company, payer, and regulatory standards.
• Monitor clinical and operational processes to identify opportunities for improvement.
• Track missing documentation and ensure timely completion of all required chart elements.
• Support quality assurance initiatives and maintain adherence to accreditation and compliance requirements.
• Utilization Review & Insurance Coordination Serve as a liaison between clinical staff, facility leadership, and the Utilization Review department.
• Assist with insurance authorizations, concurrent reviews, peer reviews, and appeals.
• Support level-of-care determinations and documentation of medical necessity.
• Coordinate communication regarding admissions, continued stay reviews, level-of-care changes, and discharge planning.
• Clinical & Team Support Participate in treatment team meetings and collaborate with clinical leadership.
• Engage with clients throughout treatment to support retention and individualized care.
• Assist with intake assessments, group facilitation, and other clinical support duties as needed.
• Help identify training and process improvement opportunities to enhance quality of care.

Qualifications

High School Diploma or GED required. Minimum one year of experience in the behavioral health, addiction treatment, healthcare, or related field preferred. Knowledge of medical terminology, clinical documentation, and utilization review processes preferred. Strong organizational, communication, and follow-up skills. Excellent interpersonal, observational, and collaborative abilities. If in recovery, a minimum of one year of sustained sobriety is required.