Clinical Utilization Review Pro: Optimize Care & Approvals

Bradford Health Services; Dallas (TX); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical Coverage

Student Loan Repayment

401(k) plan

Generous PTO

Voluntary benefits for part-time employees

Job summary

A healthcare facility in Dallas, TX, seeks a Utilization Review Coordinator responsible for managing patient care levels while ensuring compliance with healthcare regulations. The role involves collaborating with medical staff and insurance companies, conducting case reviews, and maintaining documentation. Candidates should have a relevant bachelor's degree along with experience in utilization review or case management. Strong analytical and communication skills are essential for this position.

Qualifications

• Minimum of 2 years in utilization review or case management.
• Current RN, LCSW, or LPC license preferred.
• Experience in behavioral health or chemical dependency setting is preferred.

Responsibilities

• Conduct daily reviews of patient charts to align care with clinical guidelines.
• Act as the primary contact with insurance for authorization processes.
• Ensure documentation compliance with policies and regulations.
• Collaborate with teams for continuity of care.
• Identify trends in denied claims and recommend improvements.

Skills

Knowledge of ASAM criteria

Communication skills

Analytical skills

Proficiency in EMR systems

Education

Bachelor’s degree in Nursing, Social Work, or related field

Master’s degree in a health-related field

Tools

Utilization review software

Job description

A healthcare facility in Dallas, TX, seeks a Utilization Review Coordinator responsible for managing patient care levels while ensuring compliance with healthcare regulations. The role involves collaborating with medical staff and insurance companies, conducting case reviews, and maintaining documentation. Candidates should have a relevant bachelor's degree along with experience in utilization review or case management. Strong analytical and communication skills are essential for this position.