What are the responsibilities and job description for the Utilization Review Coordinator position at ADDICTION AND MENTAL?
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 :
Why Join Bradford Health Services?
Schedule :
Full-time; Monday-Friday
