What are the responsibilities and job description for the Utilization Review Coordinator position at Hickory Recovery?
Utilization Review Coordinator - Hickory Recovery Network
REPORTS TO: Utilization Management Director.
SUPERVISOR TO: assigned Utilization Review Specialists and Utilization Review Clerks.
JOB TYPE: On-site, Full-Time
About the Role:
- The UR Coordinator is responsible for the facilitation of clinical pertinence reviews for all client admissions and continued stay requests to obtain authorization from insurance providers for treatment.
- The UR Coordinator serves as the liaison between Hickory Recovery Network (HRN) and all contracted service providers to ensure treatment is funded appropriately.
- The UR Coordinator is responsible for monthly supervision meetings 90-day and Annual Reviews with each assigned supervise.
Why Hickory Recovery?
Hickory Recovery is setting the benchmark in mental health care, especially for those facing acute challenges or dealing with co-occurring disorders. Our focus is on
- Delivering personalized, top tier care that fosters healing and improves wellbeing
- Ensuring every individual has access to the best possible support and treatment
Our Mission is to provide high quality, acute care to adults struggling with mental health issues or mental health co-occurring disorders. It’s Hickory’s primary goal to offer expert treatment for all we serve.
What We Offer:
- 401k
- Dental insurance
- Flexible schedule
- Health insurance
- PTO
- Vision insurance
- Career development
- Mental health days
- Holiday pay
Job Responsibilities:
- Complete/Monitor daily initial Prior Authorizations (PA) and Continued Stay Reviews (CSR) with insurance within the required time limit.
- Communicate with Hickory Treatment Center (HTC) facilities to gather clinical information regarding documentation, plan of care, and discharge planning.
- Submit/Monitor daily discharge summaries to insurance within 24 hours of discharge; including appropriate documentation required by insurance contracts.
- Maintain electronic documentation of approvals and denials in the EMR (Azzly) and in Utilization Review Shared Drive.
- Provide daily updates to corporate leadership regarding denials, potential problematic stays, and unfunded/charity stays.
- Complete/Monitor appeals and retroactive reviews upon discharge according to contracted providers’ requirements.
- Assist with tracking denials, unused days, appeals, and retroactive requests.
- Communicate issues regarding approval, payer requirements, and coverage limitations to HTC leadership staff/treatment team concerning the client's treatment.
- Conduct/Monitor daily chart audits for completion and accuracy of documentation, including, but not limited to, treatment plans, individual therapy notes, medical progress notes, and case management notes according to Indiana Administrative Code.
- Communicate EMR documentation deficiencies and/or discrepancies to HTC leadership staff/treatment team
- Complete and document monthly supervision meetings for assigned UR Specialists and UR Clerks.
- Complete and document 90-day reviews and Annual Reviews for assigned UR Specialists and UR Clerks.
- Review assigned UR Specialists and UR Clerks submitted documentation for quality and accuracy.
- Participate in monthly supervision with Utilization Management Director.
Minimum Qualifications:
- Education/Licensure: Bachelor's required, master's degree in social work, mental health/behavioral sciences, or related field, preferred.
- Experience: Minimum two years of experience working with clients diagnosed with chemical dependence. Experience in client assessment, treatment planning, case management, utilization review, and communication with external review organizations or comparable entities is preferred.
- Preferred Knowledge and Skills: Have thorough knowledge of psychotropic medications, ASAM Criteria and levels of care, admission and continued stay criteria, and severity of illness/intensity of service. Display strong assertiveness skills to actively advocate for the clients. Maintain impeccable attention to detail. Ability to manage time effectively and efficiently. Organize and prioritize supervisees workload.
