UM Coordinator

New Vista Behavioral Health; Cincinnati (OH); On-site; USD 42,000 - 70,000; Full time

Benefits offered by this job

Multiple medical plan options

Vista Wellness (physician/pharmacy)

Dental

Vision

Generous PTO and paid holidays

401(k) with company contribution

Life and disability coverage

Tuition reimbursement up to $15,000

Job summary

New Vista Behavioral Health is seeking a Utilization Management Coordinator to support the facility’s authorization processes for behavioral health services. You will coordinate with clinical staff, insurers, and external providers to ensure timely and compliant authorizations and maintain accurate records.

Responsibilities include reviewing documentation, tracking deadlines, coordinating peer-to-peer reviews, and assisting with appeals and denials while safeguarding patient confidentiality in a

Qualifications

• High school diploma or equivalent.
• Must be 21 or older.
• Experience in healthcare, behavioral health, medical records, insurance verification, utilization management, or a related administrative/clinical support role.
• Knowledge of insurance authorization and/or managed care processes preferred.
• Strong organizational and time-management skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple deadlines and priorities in a fast-paced healthcare environment.
• Proficiency with electronic medical records and Microsoft Office or comparable software.
• Ability to maintain confidentiality and handle sensitive patient information appropriately.

Responsibilities

• Coordinate initial, concurrent, continued-stay, and discharge-related utilization review activities.
• Obtain and track insurance authorizations for behavioral health services, including inpatient, residential, partial hospitalization, and/or intensive outpatient services as applicable.
• Verify patient insurance benefits, eligibility, and behavioral health coverage requirements.
• Submit clinical information and supporting documentation to insurance companies and managed care organizations as required.
• Maintain accurate authorization records, including approved levels of care, number of authorized days/units, review dates, and authorization numbers.
• Monitor authorization expiration dates and proactively notify clinical staff of upcoming reviews or additional information needed.
• Coordinate peer-to-peer reviews and communicate payer requests to appropriate clinical personnel.
• Assist with appeals, denials, and requests for additional clinical information.
• Communicate authorization decisions and changes in coverage to the treatment team, admissions staff, billing staff, and other appropriate departments.
• Ensure utilization management documentation is complete, accurate, timely, and maintained in accordance with facility and regulatory requirements.
• Review clinical documentation for completeness and identify missing information needed to support medical necessity reviews.
• Maintain confidentiality of protected health information in accordance with HIPAA and applicable federal and state regulations.
• Assist with identifying utilization trends, authorization issues, denials, and opportunities for improved coordination of care.
• Participate in quality improvement and utilization management activities as assigned.
• Maintain professional communication with payers, patients, families, providers, and internal departments.
• Perform other duties related to utilization management and clinical operations as assigned.

Skills

Healthcare administrative experience

Organizational skills

Verbal and written communication

Time-management

Education

High school diploma or equivalent

Tools

EMR systems

Microsoft Office

Job description

At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.

Position Summary

The Utilization Management (UM) Coordinator supports the facility’s utilization review and authorization processes for patients receiving mental health and behavioral health services. This position coordinates with clinical staff, insurance companies, managed care organizations, patients, and external providers to ensure services are appropriately authorized, documented, and reviewed in accordance with payer requirements and facility policies.

The UM Coordinator maintains accurate and timely records, tracks authorization requirements and review deadlines, assists with concurrent and retrospective reviews, and communicates changes in authorization status to the appropriate members of the treatment team.

Essential Duties and Responsibilities

• Coordinate initial, concurrent, continued-stay, and discharge-related utilization review activities.
• Obtain and track insurance authorizations for behavioral health services, including inpatient, residential, partial hospitalization, and/or intensive outpatient services as applicable.
• Verify patient insurance benefits, eligibility, and behavioral health coverage requirements.
• Submit clinical information and supporting documentation to insurance companies and managed care organizations as required.
• Maintain accurate authorization records, including approved levels of care, number of authorized days/units, review dates, and authorization numbers.
• Monitor authorization expiration dates and proactively notify clinical staff of upcoming reviews or additional information needed.
• Coordinate peer-to-peer reviews and communicate payer requests to appropriate clinical personnel.
• Assist with appeals, denials, and requests for additional clinical information.
• Communicate authorization decisions and changes in coverage to the treatment team, admissions staff, billing staff, and other appropriate departments.
• Ensure utilization management documentation is complete, accurate, timely, and maintained in accordance with facility and regulatory requirements.
• Review clinical documentation for completeness and identify missing information needed to support medical necessity reviews.
• Maintain confidentiality of protected health information in accordance with HIPAA and applicable federal and state regulations.
• Assist with identifying utilization trends, authorization issues, denials, and opportunities for improved coordination of care.
• Participate in quality improvement and utilization management activities as assigned.
• Maintain professional communication with payers, patients, families, providers, and internal departments.
• Perform other duties related to utilization management and clinical operations as assigned.

Qualifications

Required

• High school diploma or equivalent.
• Must be 21 or older
• Experience in healthcare, behavioral health, medical records, insurance verification, utilization management, or a related administrative/clinical support role.
• Knowledge of insurance authorization and/or managed care processes preferred.
• Strong organizational and time-management skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple deadlines and priorities in a fast-paced healthcare environment.
• Proficiency with electronic medical records and Microsoft Office or comparable software.
• Ability to maintain confidentiality and handle sensitive patient information appropriately.

Why You’ll Love It Here (Full-Time Benefits)

• Multiple medical plan options, Vista Wellness (physician/pharmacy), Dental, Vision
• Generous PTO and paid holidays
• 401(k) with company contribution; Life and disability coverage
• Tuition reimbursement up to $15,000 and student loan forgiveness programs