Behavioral Health Utilization & Care Coordinator

Positive Impact Health Centers INC; Decatur (GA); On-site; USD 60,000 - 80,000; Full time

Job summary

Positive Impact Health Centers INC seeks an Utilization Review Specialist to coordinate authorizations for mental health and substance use services, ensuring timely care. Collaborate with clinical staff, payors, and QA to support care continuity and accurate documentation in the EMR.

Role requires knowledge of ASAM criteria, payer rules, and strong multi-disciplinary teamwork. Local travel across PIHC sites and occasional events may be required.

Qualifications

• Minimum of 2 years’ experience in behavioral health, substance use treatment, or related clinical setting.
• Experience in utilization review, insurance authorization, or care management strongly preferred.
• Ability to interpret and apply ASAM criteria to clinical documentation.
• Experience with insurance payers and understanding of medical necessity requirements.
• Familiarity with ICD-10 codes and behavioral health diagnosis documentation.
• Strong collaboration within a multidisciplinary team and in audits/compliance.

Responsibilities

• Serve as liaison between MCOs and clinical staff to secure timely authorizations.
• Conduct pre-certification, concurrent, discharge, and retrospective reviews; initiate appeals as needed.
• Monitor patient length of stay and support care planning with staff.
• Document utilization reviews, determinations, and communications in the EMR.
• Apply payer requirements and medical necessity guidelines to clinical documentation.
• Collaborate with billing to align clinical documentation with reimbursement.
• Participate in chart audits, data collection, and quality management.
• Assist with enrolling clients in PAPs to support access to medications and services.
• Support staff training on documentation standards and stay criteria.
• Report utilization trends, denials, appeals, and service quality metrics.

Skills

Behavioral health

Utilization review

Insurance authorization

Care management

ASAM criteria

EMR documentation

Education

LSCW

LMHC/LMFT

RN

Tools

EMR systems

Job description

Positive Impact Health Centers INC seeks an Utilization Review Specialist to coordinate authorizations for mental health and substance use services, ensuring timely care. Collaborate with clinical staff, payors, and QA to support care continuity and accurate documentation in the EMR.

Role requires knowledge of ASAM criteria, payer rules, and strong multi-disciplinary teamwork. Local travel across PIHC sites and occasional events may be required.