Mental Health Utilization Review Coordinator

Lighthouse Care Center of Augusta; Augusta (GA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Referral Bonus Program

Challenging and rewarding work环境

Competitive Compensation & Generous PA

Excellent Medical, Dental, Vision and

Job summary

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Coordinator to join our team at the Augusta, GA facility. You will integrate clinical content with a focus on patient care, ensuring high-quality and cost-effective treatment aligned with our mission under UHS guidelines.

Under UR Manager, you will review data to determine eligibility for pre-certification and continued stay reviews, collaborate with physicians and staff, and ensure timely communication with insurers.

Qualifications

• Masters level education in social science field
• 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, therapist, 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

Medical Records Review

Team Collaboration

Education

Master's degree in social science

License-eligible or licensed in Georgia (LAPC, LPC, LMSW, LCSW, LMFT, LMHC)

2 years psychiatric healthcare and utilization review experience

GA or Multistate nursing license encouraged (LPN/RN)

Tools

Midas

MS4

Job description

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Coordinator to join our team at the Augusta, GA facility. You will integrate clinical content with a focus on patient care, ensuring high-quality and cost-effective treatment aligned with our mission under UHS guidelines.

Under UR Manager, you will review data to determine eligibility for pre-certification and continued stay reviews, collaborate with physicians and staff, and ensure timely communication with insurers.