Behavioral Health Utilization Review Coordinator

Turning Point Care Center; Moultrie (GA); On-site; USD 55,000 - 75,000; Full time

Job summary

Turning Point Care Center, a rural Georgia behavioral health provider, seeks an UR/UM Coordinator to oversee utilization management and optimize patient care and reimbursement. The role requires clinical licensure and solid experience in chart reviews and medical terminology.

You will conduct concurrent and extended-stay reviews, collaborate with Admissions, Clinical Staff, Nursing, Medical Records and payors, maintain MIDAS documentation, and prepare timely appeals.

Qualifications

• Licensed RN or LMSW/LAPC/LAMFT as per state board requirements.
• At least 3 years’ experience in chart analysis and utilization review.
• Proficient in medical terminology and insurances (Medicare/Commercial).

Responsibilities

• Conduct concurrent and extended-stay reviews using ASAM criteria and DSM-5 guidelines.
• Collaborate with Admissions, Clinical Staff, Nursing, Medical Records, Business Office, and providers on insurance issues.
• Review patient records, treatment plans, and clinical status; communicate payor requirements to physicians.
• Perform clinical reviews with insurance case managers by telephone and electronically.
• Maintain MIDAS documentation; run and interpret reports as needed.
• Prepare and submit timely appeals to third‑party payors with the team.
• Attend treatment team and AR/Denials meetings and maintain records per policies.

Skills

RN/LMSW/LAPC/LAMFT licensing

Chart analysis

Utilization review

Medical terminology

Education

RN, LMSW, LAPC, or LAMFT license

Tools

MIDAS

Job description

Turning Point Care Center, a rural Georgia behavioral health provider, seeks an UR/UM Coordinator to oversee utilization management and optimize patient care and reimbursement. The role requires clinical licensure and solid experience in chart reviews and medical terminology.

You will conduct concurrent and extended-stay reviews, collaborate with Admissions, Clinical Staff, Nursing, Medical Records and payors, maintain MIDAS documentation, and prepare timely appeals.