The Utilization Review Coordinator is responsible for maintaining clients continued insurance coverage for the duration of their treatment stay based upon ASAM criteria. Serves as a resource person for the health care team by completing concurrent reviews and updating them on insurance information.
Job Duties
- Promote the mission, vision, and values of the organization
- Knowledgeable of criteria for RTC, PHP, and IOP private insurance coverage.
- Complete concurrent reviews to keep clients at RTC, PHP, and IOP level of care
- Participates in interdisciplinary clinical team meetings to discuss each client’s active treatment and review of medical necessity.
- Communicate daily with admissions personnel regarding insurance coverage.
- Strong analytical, organizational and time management and computer skills.
- Ability to negotiate medical necessity on behalf of the client.
- Serve as liaison for billing company for the duration of the client’s length of stay.
- Informs medical/psychiatric staff when a peer review must be completed.
- Compiles and maintains data as needed or when requested.
Minimum Qualification:
- College degree
- Attention to detail and ability to multitask.
- Ability to answer phone calls, emails and other daily correspondence.
- Capable of communicating to business associates at all levels. Maintain confidentiality regarding clients, insurance, residents and associates.
- Interest in non-profit and social services.
- Skills in Microsoft Word, Excel and PowerPoint
- Ability to maintain high standards of productivity, cooperation, attendance and efficiency in work habits.
Job Type: Full-time
Healthcare setting:
Schedule:
- 8 hour shift
- Day shift
- Holidays
- Monday to Friday
- Weekends as needed
Experience:
- Utilization review: 1 year (Required)
Work Location: In person