Horizon Behavioral Heal·Lynchburg, Virginia
The specialist proactively monitors the utilization of behavioral healthcare services to ensure quality and medical necessity. They review medical records for compliance with federal, state, and insurance regulations while reporting to the CQI Manager.
full-time (37.5 hours per week)
Location: Lynchburg VA, 24501
Compensation dependent on experience
The Behavioral Healthcare Utilization Review Specialist works on-site, and will proactively monitor utilization of services for clients, reviewing for quality of services and medical necessity. The employee will review clients’ medical records to ensure appropriate utilization of treatment resources, medical necessity, proper documentation, and compliance with federal and state regulations, and certification requirements of insurance plans or other managed care organizations (MCOs). This position will report to the CQI Manager.
Master’s degree in social work, Mental Health Counseling, or related health field preferred.
Types of Experience
(2) Two years of continuous quality improvement and/or utilization review experience. Preference will be given to individual with at least one year of managed care experience. Behavioral Health experience is desirable.
An equivalent combination of education and experience that provides the candidate with the required knowledge, skills and abilities may be considered.
The best benefits for those who take care of the community
We’re proud to offer some of the best benefits options in Central Virginia.
Participation in the Virginia Retirement System (VRS) is exclusively for public service workers in Virginia, while several options exist for life, health, dental, and vision insurance.
Emphasis on work-life balance means a generous annual leave policy ensuring time for wellness with separate time allocated for sick leave and additionally for paid holidays.
Stay active with Horizon’s annual wellness programs and various opportunities to interact with the community through the year.
Horizon’s clinical sites are NHSC/HRSA approved for clinical student loan repayment and qualify for both the Public Service Loan Forgiveness (PSLF) and the Behavioral Health State Loan Repayment (BHLRP) programs.
If you are interested in continuing your education, working at Horizon qualifies you to receive discounts at some local universities.
To Apply – Please visit our online career center at https://www.horizonbh.org/careers/ [https://www.horizonbh.org/careers/]
Horizon Behavioral Health is an Equal Opportunity Employer (EOE).
Requires a Bachelor's degree in a human services field and two years of experience in continuous quality improvement or utilization review. Knowledge of DSM 5, CPT codes, ICD 10, and Medicaid/MCO regulations is essential.
Market context
Behavioral-health roles in Virginia commonly draw steady demand as agencies and treatment programs look for clinicians who can support counseling, care coordination, and recovery services. These positions are competitive because a valid CSAC license is required, while a psychology or counseling degree and treatment-industry experience are preferred; benefits often include PTO and health-related coverage. Review the AI-summarized requirements and benefits on this platform to save time, and confirm your licensure details before applying.