What are the responsibilities and job description for the Utilization Review Coordinator position at ADDICTION AND MENTAL HEALTH SERVICES, LLC?
Position Title: Utilization Review Coordinator
Department: Administrative
Reports To: Regional Director
Supervises: N/A
About Bradford Health Services:
Bradford Health Services has been providing exceptional care for over 40 years, helping individuals and families recover from addiction and rebuild their lives. Our team is dedicated to providing patient-first care in a supportive and compassionate environment. We are looking for skilled and passionate Utilization Review Coordinators to join our team and help us continue to make a difference.
Position Overview:
As a Utilization Review Coordinator, you will play a vital role in managing insurance certification processes, including pre-certification, continued stay reviews, and follow-ups on insurance denials, appeals, and reconsiderations. You will collaborate with clinical staff to ensure optimal care for patients while maintaining compliance with applicable laws and policies.
Key Responsibilities:
- Perform pre-admission certification reviews, continued stay reviews, and manage appeals, denials, and reconsiderations.
- Maintain a detailed log of all utilization review activities and documentation in the patient electronic health record system.
- Ensure correspondence related to certifications, appeals, and denials is properly documented and stored.
- Collaborate with clinical and crisis staff to ensure appropriate documentation and managed care criteria are met.
- Complete and report quality improvement indicators for utilization management.
- Provide education to staff regarding documentation requirements and managed care standards.
- Maintain effective communication with insurance agencies and referral sources.
Qualifications:
- Education/Experience: Current RN, LPC, LMFT, LMSW, or LCSW license preferred. Minimum two years' experience in utilization review preferred.
- Strong verbal and written communication skills.
- Proficient in Microsoft Office and familiar with electronic health record systems.
- Detail-oriented with excellent organizational and time management skills.
- Ability to work in a fast-paced environment and handle multiple priorities.
- Commitment to maintaining patient confidentiality and compliance with HIPAA and 42 CFR Part 2.
Why Join Bradford Health Services?
- Be part of a mission-driven team dedicated to improving lives.
- Opportunity for professional growth in a supportive environment.
- Competitive compensation and benefits package.
- Work with a dynamic team committed to excellence and innovation.
Schedule:
Full-time; Monday-Friday
