Utilization Review Coordinator

Description

Odyssey Behavioral Healthcare’s diverse network of programs treats adults and adolescents with eating disorders, psychiatric disorders, dual diagnoses, and addictive disorders under three distinct networks: Psychiatric, Eating Disorder, and Outpatient. Providing a continuum of care that includes inpatient, intensive residential, partial hospitalization, intensive outpatient, detoxification, and transitional living programs, Odyssey operates facilities and provides affiliated outpatient services in over 35 locations and across nine states with over 600 total beds.

How You Will Contribute:

The Utilization Review Coordinator for Odyssey Outpatient Network will work collaboratively with clinical and administrative teams to meet organizational goals and improve clinical outcomes and client satisfaction across the outpatient network.  The UR Coordinator is responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness, acting as a client advocate and representative of the Outpatient Network.

Relationships and Contacts

Within the organization:  Initiates and maintains strong professional relationships with peers, immediate supervisor, and leadership throughout the organization.

Outside the organization:  Initiates and maintains strong professional relationships with commercial payers, clients and families, and vendors, as needed.

Essential Responsibilities

1. Initiates and maintains frequent and close working relationships with the utilization review, revenue cycle, admissions, business development, facility leadership, and clinical team members.
2. Initiates and maintains frequent and close working relationships with commercial payers, client families and vendors, as needed.
3. Conducts initial pre-certification authorizations, continued stay reviews, care coordination, and discharge planning for appropriateness of treatment.
4. Inputs and maintains authorization status in the appropriate EMR systems for billing purposes.
5. Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, care throughout the medical management process.

Additional Responsibilities

1. Facilitates Peer Reviews when needed.
2. Manages appeals for services denied as needed.
3. Assists with verifying insurance coverage as needed.
4. Adheres to all applicable internal and regulatory requirements.
5. Performs other duties as assigned.

Qualifications

What We Are Seeking:

Education and Experience

Bachelor’s degree required. Minimum of 3 years of relevant experience in the areas Utilization Management and/or behavioral healthcare. Experience with mental health PHP/IOP, eating disorder PHP/IOP, and/or psychiatric hospital experience desired.

What We Offer:

•        Collaborative environment dedicated to clinical excellence
•        Multiple Career Development Pathways
•        Company Supported Continuing Education & Certification
•        PPO & HDHP Health Plan Options
•        Flexible Dental & Vision Plan Options
•        100% Company Paid EAP Emotional Well-Being Support
•        100% Company Paid Critical Illness (with health enrollment plan)
•        100% Company Paid Life & ADD
•        401K with Company Match
•        Company-Sponsored HSA, FSA, & DSA Tax Savings Accounts
•        Generous Team Member Referral Program
•        Parental Leave

Odyssey Behavioral Healthcare provides equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunity applies to all terms and conditions of employment. Odyssey Behavioral Healthcare reserves the rights to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains “At-Will.”