UR COORDINATOR

Universal Health Services, Inc.; Augusta (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

Universal Health Services, Inc. in Augusta, MI is seeking a Utilization Review Coordinator responsible for reviewing patient insurance benefits and determining the appropriate level of care. The role involves contacting health plan providers and documenting necessary approvals.

Candidates must have an appropriate degree in nursing or psychology, as well as experience in utilization review or psychiatric settings. Strong interpersonal and organizational skills are required, alongside a proficient understanding of insurance protocols.

Qualifications

• Minimum of 1 year of experience in utilization review/case management preferred.
• Minimum of 1 year facility-based psychiatric/substance abuse experience preferred.

Responsibilities

• Review patient insurance benefits and ascertain level of care pre-certifications.
• Document requests and authorization approval numbers in the system.
• Coordinate clinical and after-care needs with the treatment team.
• Attend treatment team meetings and management meetings.

Skills

Interpersonal skills

Understanding of insurance benefits

Organizational skills

Attention to detail

Customer relation skills

Education

Nursing degree or Bachelor's in psychology/social work

Master's degree preferred

Tools

MS Word

Excel

Job description

Responsibilities

Skywood Recovery Center is a residential treatment facility offering integrated treatment for addiction and mental health conditions. Skywood Recovery provides individual and group therapy, experiential therapy, equine and art therapy, and yoga. Located in Augusta, MI, a convenient drive from Kalamazoo and Lansing, MI, the campus offers a restorative environment with opportunity to enjoy the outdoors.

The Utilization Review Coordinator is responsible for reviewing patient insurance benefits and ascertaining level of care (LOC) pre‑certifications.

• Reviews and understands insurance information provided by the Admissions Center, determines which benefits are available to client, and clarifies discrepancies or confusion.
• Determines what LOC the client meets and what ASAM (American Society of Addiction Medicine) criteria support that LOC based on patient’s benefits.
• Once a care manager is established, contacts health plan provider and requests most appropriate LOC for client.
• Documents in system and in a paper file the request made and authorization approval number/contact information.
• Attends pass down/treatment team meetings as assigned, reviews weekly UR update information.
• Attends and participates in treatment team meetings and management meetings.
• Coordinates patient’s clinical and after‑care needs with treatment team.
• Performs all other duties as required or assigned.

Knowledge, Skills and Abilities

• Must have high level of interpersonal skills. Position continually requires demonstrated poise, professionalism, tact and diplomacy.
• Specific knowledge of substance abuse and or mental health treatment on a clinical level.
• Ability to understand insurance benefits and follow insurance protocols within appropriate time frames.
• Ability to learn levels of care guidelines and medical necessity criteria.
• Must have strong knowledge of a variety of computer software applications in word processing and spreadsheets (MS Word, Excel).
• Excellent organizational skills with the ability to prioritize workload and meet deadlines.
• Ability to pay continual attention to detail in documenting files.
• Understands need for and maintains appropriate confidentiality at all times when interacting with patients, residents, families, visitors, referral sources and all other contacts.
• Exhibits excellent customer relation skills as evidenced by supportive and constructive communication with all contacts including coworkers, patients, residents, visitors, families and referral sources.

Education and Experience

• Nursing degree or Bachelor’s degree in psychology, social work, or related field required or commensurate experience. Master’s degree preferred.
• Minimum of 1 year of experience in utilization review/case management preferred.
• Minimum of 1 year facility based psychiatric/substance abuse experience preferred.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.