UR Coordinator

SAN-Antonio-Behavioral-Healthcare-Hospital-; San Antonio (TX); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health Insurance

Vision Insurance

Dental Insurance

401K Retirement Plan

Healthcare Spending Account

Dependent Care Spending Account

PTO Plan with Holiday Premium Pay

Life Insurance

Short and Long-Term Disability

Job summary

SAN-Antonio-Behavioral-Healthcare-Hospital- seeks a Utilization Review Coordinator to bridge between clinicians, patients, and insurers, ensuring care meets guidelines and appropriate authorizations are secured.

The role involves reviewing medical records, coordinating with treatment teams, and monitoring length of stay to support cost-effective care.

Qualifications

• Highschool Diploma or GED required; bachelor’s degree preferred.
• Experience in behavioral healthcare preferred.
• Must possess or obtain CPR certification and de-escalation training before new hire orientation.

Responsibilities

• Submitting clinical documentation to health insurance for prior authorization and certification.
• Reviewing patient charts to ensure medical necessity and regulatory compliance.
• Ensuring HIPAA and insurance regulations across documentation.
• Acting as liaison between clinical staff, billing, and third-party payers.
• Participating in interdisciplinary treatment teams to align care with insurance days.
• Monitoring length of stay against insurance timelines to avoid penalties.
• Advising on missing documentation to justify continued care.
• Reviewing denial letters to identify contract or clinical reasons for denial.
• Coordinating peer-to-peer reviews with insurance medical directors.
• Drafting and submitting urgent clinical appeal packets within 24–72 hours.
• Perform other duties as required.

Skills

Verbal and written communication

Medical record review for medical need

Negotiation skills

Organizational skills

Problem solving

Education

Highschool Diploma/GED

Bachelor’s degree preferred

Tools

Microsoft Office Suite

Job description

We are seeking a Utilization Review (UR) Coordinator to join our team. The UR Coordinator is a healthcare professional who bridges the gap between medical providers, patients, and insurance companies. They evaluate medical records to ensure that patient treatments meet established clinical guidelines, secure insurance authorizations, and manage healthcare costs while maintaining quality care.

Essential Duties:

• Prior Authorization & Certification: Submitting clinical documentation to health insurance to approve planned procedures, hospital admissions, or continued stays
• Medical Necessity Evaluation: Reviewing patient charts to ensure the level of care matches the patient\'s condition and meets both regulatory and insurance standards
• Compliance & Auditing: Ensuring all medical documentation adheres to HIPAA and insurance regulations
• Liaison Duties: Acting as a central point of contact between clinical staff, billing departments, and third-party payers
• Treatment Team Collaboration: Attends interdisciplinary treatment team to gather clinical justifications, track therapy progress, and align care plans with approved insurance days
• Length-of-Stay Tracking: Monitors how long patients stay in the facility against approved insurance timelines to reduce financial penalties
• Insurance Alignment: Advises the clinical team on what documentation is missing or needed to justify continued care to the insurance company
• Denial Analysis: Reviews insurance denial letters to pinpoint the exact contractual or clinical reason why the level of care was rejected
• Peer-to-Peer Coordination: Schedules and prepares facility psychiatrists for immediate telephonic reviews with insurance medical directors
• Expedited Appeals Submission: Drafts and submits urgent clinical appeal packets within tight, state-mandated 24 to 72-hour windows for active patients
• Perform other duties as per the requirements of the organization.

Education and/or Licensure – Highschool Diploma/GED required. Bachelor’s degree preferred.

Experience – Experience in behavioral healthcare preferred.

Additional Requirements – Must possess or obtain a valid CPR certification and de-escalation training before completing new hire orientation.

Knowledge, Skills, and Abilities:

• Exceptional verbal and written skills to translate complex insurance rules to therapists, psychiatrists, and families
• Ability to review complex medical records to extract data that proves medical necessity
• Strong negotiation skills to defend treatment plans during difficult conversations with insurance medical directors
• Organizational skills
• Proven expertise solving problems
• Proficiency in Microsoft Office Suite and other related software to perform necessary tasks

Physical Requirements:

• Stationary Position: Substantial time spent sitting at a desk and operating a computer.
• Office Mobility: Ability to walk, reach, and move around an office environment.
• Lifting/Carrying: Occasional, light lifting, usually limited to 10–25 lbs.

401K, Medical/Dental insurance, FMLA and Short-Term Disability

• Health Insurance
• Vision Insurance
• Dental Insurance
• 401K Retirement Plan
• Healthcare Spending Account
• Dependent Care Spending Account
• PTO Plan with Holiday Premium Pay
• Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
• Short and Long-Term Disability (with additional buy-in opportunities)