Teams at Bradford Health Services

Conduct utilization reviews across behavioral health and substance use treatment, including admissions, precertifications, concurrent reviews, continued-stay reviews, and retrospective reviews. Track payer authorizations, deadlines, clinical documentation, and level-of-care approvals. Collaborate with treatment teams, insurers, case managers, and revenue cycle partners; prepare peer-review and appeal materials; identify documentation gaps; support denial reviews and compliance with payer, HIPAA, and regulatory requirements.

Reviews medical records, treatment plans, and clinical documentation to determine medical necessity and service appropriateness. Coordinates with providers, insurers, and case managers to obtain information, make authorization decisions, maintain compliant records, and apply clinical guidelines, payer policies, and healthcare regulations.

Identifies and qualifies healthcare business opportunities through research, networking, outreach, and client meetings. Builds relationships with prospective clients, presents tailored healthcare solutions, collaborates on proposals, tracks sales activity in Salesforce, and monitors industry, competitor, and regulatory developments. The role supports market expansion, revenue growth, client satisfaction, and strategic decision-making within the behavioral healthcare sector.