Clinical Utilization Review Coordinator (Mental Health)

Universal Health Services; Augusta (GA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Referral Bonus Program

Paid Time Off

Excellent Medical/Dental/Vision plans

401(k) with company match

Job summary

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Coordinator to join our Case Management team in Augusta, GA. The role focuses on clinical data review to determine eligibility for pre-certification and continued stay reviews while coordinating with physicians and staff to ensure timely approvals.

The position requires a master’s degree in a social science field, GA licensure eligibility, and at least 2 years in psychiatric care with utilization review experience.

Qualifications

• Masters level education in social science field (social work, counseling, sociology, psychology).
• Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC)
• Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review.
• Nurses with a current GA or Multistate license encouraged to apply. (LPN, RN)

Responsibilities

• Review clinical content of medical records, participate in treatment team meetings, and collaborate with physicians, therapists, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved.
• Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4.
• Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems, in addition to other job duties.

Skills

Utilization Review

Clinical coordination

Insurance liaison

Midas

MS4

Education

Master's degree in social science

Tools

Midas

MS4

Job description

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Coordinator to join our Case Management team in Augusta, GA. The role focuses on clinical data review to determine eligibility for pre-certification and continued stay reviews while coordinating with physicians and staff to ensure timely approvals.

The position requires a master’s degree in a social science field, GA licensure eligibility, and at least 2 years in psychiatric care with utilization review experience.