Behavioral Health Utilization Review Specialist

Turning Point Care Center, Inc.; Moultrie (GA); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision Plans

401(k) with company match

SoFi Student Loan Refinancing Program

Tuition savings for nursing education

Job summary

Turning Point Care Center, Inc. in rural South Georgia seeks a dedicated Utilization Review/Utilization Management Coordinator to monitor care appropriateness and reimbursement.

You will review records, coordinate with inpatient and outpatient teams, and ensure compliance with applicable requirements. The role requires nursing or counseling credentials and experience with chart reviews and insurer communications.

Qualifications

• Licensed nursing or counseling/therapy credential required
• Experience with chart review, utilization review, and treatment planning a plus
• Familiarity with ASAM DSM-5 criteria and insurance requirements preferred

Responsibilities

• Conduct concurrent and extended-stay reviews using ASAM criteria and DSM-5 guidelines to determine medical necessity and discharge criteria
• Collaborate with Admissions, Clinical Staff, Nursing, Medical Records, Business Office and providers to address insurance issues
• Review patient records, treatment plans and acuity; communicate third-party payor requirements to physicians and team
• Perform clinical reviews with insurance case managers via telephone/electronically
• Maintain accurate documentation in MIDAS and other utilization records; run 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 policy and standards

Skills

Utilization review

Clinical documentation

Insurance coordination

Interdisciplinary collaboration

Education

RN/LMSW/LAPC/LAMFT licensed

BSN/MSN/LCSW/LPC/LMFT preferred

Tools

MIDAS system

Medical records

Job description

Turning Point Care Center, Inc. in rural South Georgia seeks a dedicated Utilization Review/Utilization Management Coordinator to monitor care appropriateness and reimbursement.

You will review records, coordinate with inpatient and outpatient teams, and ensure compliance with applicable requirements. The role requires nursing or counseling credentials and experience with chart reviews and insurer communications.