UR COORDINATOR
Master's
Responsibilities
Qualifications
Licensed Behavioral Health Professional
Position Summary
The Utilization Review / Utilization Management Coordinator is responsible for coordinating authorization and reimbursement activities to ensure patients receive appropriate levels of care throughout treatment. This position works collaboratively with Intake, Clinical Services, Medical Records, Business Office, Nursing, and Providers to communicate clinical information to payers and obtain authorization for services.
The ideal candidate is a licensed behavioral health professional with experience in mental health treatment, a strong understanding of ASAM criteria, and the ability to effectively advocate for patients with insurance providers.
Qualifications
Required:
- Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or a related behavioral health field.
- Current state licensure as one of the following:
- Licensed Clinical Social Worker (LCSW/LICSW)
- Licensed Mental Health Counselor (LMHC)
- Licensed Professional Counselor (LPC)
- Licensed Marriage & Family Therapist (LMFT)
- Other equivalent independent behavioral health license
- Two (2) years of experience in behavioral health and/or substance use disorder treatment.
- Working knowledge of ASAM criteria and DSM-5.
- Strong clinical assessment, documentation, and communication skills.
- Proficiency with electronic health records and Microsoft Office applications.
Preferred:
- Previous Utilization Review, Utilization Management, Case Management, or Insurance Authorization experience.
- Experience in inpatient, residential, PHP, IOP, treatment settings.
- Knowledge of managed care and commercial insurance requirements.
Qualifications
Essential Job Duties
- Conduct telephonic and electronic utilization reviews with insurance companies and managed care organizations.
- Obtain initial, concurrent, and continued stay authorizations for patient treatment services.
- Utilize ASAM criteria and DSM-5 diagnostic criteria to determine medical necessity and appropriate levels of care.
- Assess treatment progress and support continued stay recommendations.
- Identify high-risk, complex, or denial-prone cases and collaborate with clinical leadership to address barriers to care.
- Partner with therapists, providers, and interdisciplinary teams to gather and communicate clinical information.
- Maintain accurate, timely, and compliant documentation of all utilization review activities.
- Track authorization status and ensure payer deadlines and requirements are met.
- Assist with appeals, reconsiderations, and denial management activities.
- Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
- Participate in quality improvement efforts related to utilization management and reimbursement processes.