Utilization Review Coordinator

Utilization Review Coordinator
Schedule:

• 8:30am-5pm M-F

Compensation:

• $50K-$65K per year

We’re looking for people who are excited to join our passionate, authentic, and courageous team. We’re uncompromising in the pursuit of excellence: our core values are more than just words on a page — we live and breathe them. To work at our company is to make a promise to help our patients achieve their wildest dreams. Our mission is to unlock human potential and save a million lives over the next hundred years.

Our company operates Residential Treatment Programs for individuals with Substance Abuse Disorder. We seek not merely to restore sobriety, but to transform our patients’ worlds from a state of darkness to vibrant technicolor. We believe that treatment is local, individualized, holistic, and relational.

Summary
The Utilization Review Coordinator performs all functions related to utilization review. This role acts as a clinical liaison between payers and facilities, providing information and feedback to assist in optimal patient care reimbursement. The coordinator partners with Revenue Cycle Management to ensure all processes are managed effectively.

Responsibilities

• Ensure all provided care is authorized within contractual timelines

• Initiate precertification for patients entering treatment programs using clinical knowledge

• Conduct concurrent reviews on patients to ensure documentation meets insurance requirements for level of care

• Track patients across locations to ensure timely and accurate billing

• Implement quality control by communicating effectively with treatment teams

• Obtain authorization for patients in Medicaid facilities

• Lead retroactive appeals to obtain authorization for discharged patients

• Collaborate with Revenue Cycle Management to resolve related issues

Minimum Qualifications

• Bachelor’s degree in behavioral health or related field required

• 1-2 years of professional clinical experience

• Clinical license preferred

• Familiarity with SharePoint and Excel

• Proficiency in Microsoft Office

At our company, we value diversity and are proud to be an Equal Employment Opportunity Employer. We respect the time and energy it takes to apply and will respond promptly to your application. Thank you for your interest in joining our team.