Clinical Utilization Review Coordinator

Universal Health Services; Moultrie (GA); On-site; USD 60,000 - 85,000; Full time

Job summary

Universal Health Services in Georgia is seeking a licensed professional to serve as Utilization Review / Utilization Management Coordinator. The role collaborates with clinical and administrative staff to coordinate patient information and communicate with insurers for benefits assignment.

Responsibilities include conducting clinical reviews by phone and electronically, applying ASAM criteria (DSM-V) to determine admission and discharge criteria, and ensuring records comply with accrediting and

Qualifications

• Licensure through state board for nursing or counseling/therapy.
• Three (3) years of experience in chart analysis, utilization review, medical/clinical terminology, and acuity of illness.
• Knowledge of Traditional Medicare, Medicare Advantage Plans, and Commercial Plans.
• Knowledge/experience with chemical dependency programs, mental health programs, situational evaluations, and crisis intervention (preferred).

Responsibilities

• Performs clinical reviews over the telephone and electronically.
• Utilizes ASAM criteria (DSM-V) to determine appropriateness of admission, continued stay, discharge criteria and identifies high‑risk cases.
• Adheres to accrediting and regulatory agency requirements in maintaining records to ensure compliance.

Skills

Chart analysis

Utilization review

Medical terminology

Acuity of illness

Crisis intervention

Education

RN license

Counseling/therapy license (LMSW/LPC/LCSW/LAMFT)

Job description

Universal Health Services in Georgia is seeking a licensed professional to serve as Utilization Review / Utilization Management Coordinator. The role collaborates with clinical and administrative staff to coordinate patient information and communicate with insurers for benefits assignment.

Responsibilities include conducting clinical reviews by phone and electronically, applying ASAM criteria (DSM-V) to determine admission and discharge criteria, and ensuring records comply with accrediting and