UR COORDINATOR

Skywood Recovery; Michigan; On-site; USD 65,000 - 85,000; Full time

Job summary

Skywood Recovery in Michigan is seeking a Utilization Review Coordinator responsible for reviewing patient insurance benefits and determining appropriate levels of care. This role involves coordinating with care managers and attending treatment meetings to ensure patient needs are met efficiently.

The ideal candidate must possess strong interpersonal skills and a relevant degree, with experience in utilization review preferred. Proficiency in MS Word and Excel is required, along with the ability to maintain confidentiality and attention to detail.

Qualifications

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

Responsibilities

• Review patient insurance benefits and ascertain level of care pre‑certifications.
• Attend treatment team meetings and coordinate clinical needs.
• Document requests and authorization information.

Skills

Interpersonal skills

Knowledge of substance abuse treatment

Understanding insurance benefits

Organizational skills

Customer relation skills

Education

Bachelor’s degree in psychology, social work, or related field

Nursing degree

Master’s degree preferred

Tools

MS Word

Excel

Job description

Responsibilities

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 the client, and clarifies discrepancies or confusion.
• Determines what level of care (LOC) the client meets and what ASAM criteria support that LOC based on the client’s benefits.
• Once a care manager is established, contacts the health plan provider and requests the most appropriate LOC for the client.
• Documents in the 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 the patient’s clinical and after‑care needs with the treatment team.
• Performs all other duties as required or assigned.

Knowledge, Skills and Abilities

• Must have high level of interpersonal skills. The 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.