Clinical Utilization Review Coordinator

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

Benefits offered by this job

Medical

Dental

Vision

Life Insurance

Flexible Spending Accounts

Health Savings Accounts

Short and Long Term Disability

401K with match

Employee Stock Purchase Plan

Discounted benefits

Job summary

Turning Point Care Center in Georgia seeks an Utilities Review/Management Coordinator to coordinate patient information with insurers for benefits and to perform clinical reviews by phone and electronically.

Ideal candidates hold RN, LMSW, LAPC, or LAMFT licensure with at least 3 years of chart analysis and utilization review experience, plus knowledge of Medicare and commercial plans. Experience in chemical dependency and mental health programs is preferred.

Qualifications

• Active state licensure (nursing or counseling/therapy).
• Minimum 3 years in chart analysis, utilization review, medical terminology, and acuity of illness.
• Knowledge of Traditional Medicare, Medicare Advantage, and Commercial Plans.
• Experience with chemical dependency and mental health programs preferred.

Responsibilities

• Coordinate and communicate patient information to insurers for benefits assignment.
• Perform clinical reviews over the telephone and electronically.
• Apply ASAM criteria (DSM-V) to determine admission, continued stay, and discharge criteria.
• Maintain records to comply with accrediting and regulatory requirements.

Skills

Chart analysis

Utilization review

Medical terminology

Acuity of illness

Education

RN

LMSW

LAPC

LAMFT

Job description

Turning Point Care Center in Georgia seeks an Utilities Review/Management Coordinator to coordinate patient information with insurers for benefits and to perform clinical reviews by phone and electronically.

Ideal candidates hold RN, LMSW, LAPC, or LAMFT licensure with at least 3 years of chart analysis and utilization review experience, plus knowledge of Medicare and commercial plans. Experience in chemical dependency and mental health programs is preferred.