Utilization Review Coordinator

Description

Who We Are

STR Behavioral Health’s premier mental health and addiction treatment center located in Levittown. The programs we offer include detox, residential, partial hospitalization, intensive outpatient, and outpatient care with licensed recovery housing. The approach at our treatment centers is firmly rooted in individualized, person-centered care to help clients uncover the “why” behind their disorders and help them build foundational relationships that help answer the “how” in moving forward. We work closely with every client to create personalized, high-quality treatment plans that cater to their specific needs and increase their chances of success. Our clinical team also meets regularly to adjust each treatment plan as the client progresses through treatment. Additionally, we work closely with each client’s family and other stakeholders to help people thrive in recovery.

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

Position Summary

The Utilization Review Coordinator will conduct initial and concurrent reviews with respective payers, review client’s clinical charts, interpret need and communicate with insurance companies to ensure authorization for the appropriate length of stay and level of care. The UR Coordinator will communicate treatment needs to insurance companies, review and submit medical records as requested, document authorizations, appeal authorizations as needed and facilitate communications between billing and clinical department

Position Responsibilities

Essential Responsibilities

1. Reviews admissions to determine medical necessity and appropriateness of treatment
2. Submit pre-assessments to the insurance company for initial authorizations
3. Regularly review client charts and changes to enhance knowledge base of each client’s unique case
4. Secures necessary data for extended stay reviews
5. Presents abstract clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment
6. Communicates all extensions of treatment to clinical teams and billing team
7. Tack and report authorization trends by insurance company
8. Give clinical team feedback on clinical charts and authorizations in an effort to enhance their knowledge base and understanding of insurance guidelines

Additional Responsibilities

1. Abides by all company policies and procedures.
2. Understands the services provided by the company.
3. Consistently provides optimum Customer Service to all internal and external customers.
4. Performs other duties and projects as assigned.
5. Learns billing system (Sigmund) to step in and help with other job functions if/when needed.

Qualifications

Minimum Requirements

Education and Experience

  A High School Diploma required, BA in psychology or related field preferred with a minimum of 3-5 years in the UR department. A Minimum of 1 year experience providing direct care to clients and ability to interpret chart terminology. Expert in ASAM and insurance measures that will dictate LOC. Ability to interpret chart terminology, excellent knowledge of addiction, proficient in Microsoft word and excel. Must understand and familiarity of basic EMR software. Strong Knowledge if Mental Health medical necessity criteria for residential and outpatient levels of care

Physical Requirements

• While performing the duties of this job, the employee will be required to communicate with peers/general public, clients and/or vendors
• Tolerant to various noise levels: noise level in the work environment varies – may be very quiet to moderate
• Job performance will require the ability to move throughout the building as well as sit or remain stationary for extended periods of time
• While performing the duties of this job, the employee may be required to talk or hear, sit, stand, walk, reach, climb or balance, stoop, kneel, crouch

Skill Competencies

• Demonstrates a comprehensive understanding of the admission, concurrent, continued stay and retrospective reviews using the established facility criteria.
• Demonstrates knowledge of medical and behavioral health terminology, and techniques used to diagnose and treat various medical conditions, including practices, standards of care, symptoms, treatment alternatives, medications used for treatment, and preventative healthcare measures.
• Demonstrates excellent verbal and written communication skills.
• Demonstrates a high level of initiative and follow through.
• Demonstrates commitment to the mission, vision, and values of STR Behavioral Health.

STR Behavioral Health 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. STR Behavioral  Health 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.”