UR COORDINATOR

Henderson Hospital; Spokane (WA); Vor Ort; USD 70.000 - 90.000; Vollzeit

Zusammenfassung

Henderson Hospital seeks a Licensed Behavioral Health Professional to coordinate authorization and reimbursement activities, ensuring patients receive appropriate levels of care. You will collaborate with Intake, Clinical Services, Medical Records, and Payors to obtain authorizations and communicate clinical information.

The ideal candidate has ASAM and DSM-5 knowledge, strong assessment and documentation skills, and proficiency with EHR and MS Office to advocate for patients with insurance

Qualifikationen

• Master's degree in social work, counseling, marriage & family therapy, psychology, or related behavioral health field.
• Current state licensure as LCSW/LICSW, LMHC, LPC, LMFT, or other equivalent independent behavioral health license.
• Two years of experience in behavioral health and/or substance use treatment.
• Working knowledge of ASAM criteria and DSM-5.
• Strong clinical assessment, documentation, and communication skills.
• Proficiency with electronic health records and Microsoft Office applications.

Aufgaben

• Conduct telephonic and electronic utilization reviews with insurance companies and managed care organizations.
• Obtain initial, concurrent, and continued stay authorizations for patient treatment services.
• Utilize ASAM criteria and DSM-5 diagnostic criteria to determine medical necessity and appropriate levels of care.
• Assess treatment progress and support continued stay recommendations.
• Identify high-risk, complex, or denial-prone cases and collaborate with clinical leadership to address barriers to care.
• Partner with therapists, providers, and interdisciplinary teams to gather and communicate clinical information.
• Maintain accurate, timely, and compliant documentation of all utilization review activities.
• Track authorization status and ensure payer deadlines and requirements are met.
• Assist with appeals, reconsiderations, and denial management activities.
• Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
• Participate in quality improvement efforts related to utilization management and reimbursement processes.

Kenntnisse

ASAM criteria knowledge

DSM-5 knowledge

Clinical assessment

Documentation skills

Communication skills

MS Office proficiency

EHR proficiency

Ausbildung

Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or related behavioral health field

Tools

Electronic Health Records (EHR)

Microsoft Office

Jobbeschreibung

Responsibilities

Licensed Behavioral Health Professional

Position Summary

The Utilization Review / Utilization Management Coordinator is responsible for coordinating authorization and reimbursement activities to ensure patients receive appropriate levels of care throughout treatment. This position works collaboratively with Intake, Clinical Services, Medical Records, Business Office, Nursing, and Providers to communicate clinical information to payers and obtain authorization for services.

The ideal candidate is a licensed behavioral health professional with experience in mental health treatment, a strong understanding of ASAM criteria, and the ability to effectively advocate for patients with insurance providers.

Qualifications

Required:

• Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or a related behavioral health field.
• Current state licensure as one of the following:
  • Licensed Clinical Social Worker (LCSW/LICSW)
  • Licensed Mental Health Counselor (LMHC)
  • Licensed Professional Counselor (LPC)
  • Licensed Marriage & Family Therapist (LMFT)
  • Other equivalent independent behavioral health license
• Two (2) years of experience in behavioral health and/or substance use disorder treatment.
• Working knowledge of ASAM criteria and DSM-5.
• Strong clinical assessment, documentation, and communication skills.
• Proficiency with electronic health records and Microsoft Office applications.

Preferred:

• Previous Utilization Review, Utilization Management, Case Management, or Insurance Authorization experience.
• Experience in inpatient, residential, PHP, IOP, treatment settings.
• Knowledge of managed care and commercial insurance requirements.

Qualifications

Essential Job Duties

• Conduct telephonic and electronic utilization reviews with insurance companies and managed care organizations.
• Obtain initial, concurrent, and continued stay authorizations for patient treatment services.
• Utilize ASAM criteria and DSM-5 diagnostic criteria to determine medical necessity and appropriate levels of care.
• Assess treatment progress and support continued stay recommendations.
• Identify high-risk, complex, or denial-prone cases and collaborate with clinical leadership to address barriers to care.
• Partner with therapists, providers, and interdisciplinary teams to gather and communicate clinical information.
• Maintain accurate, timely, and compliant documentation of all utilization review activities.
• Track authorization status and ensure payer deadlines and requirements are met.
• Assist with appeals, reconsiderations, and denial management activities.
• Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
• Participate in quality improvement efforts related to utilization management and reimbursement processes.

Essential Job Duties

• Conduct telephonic and electronic utilization reviews with insurance companies and managed care organizations.
• Obtain initial, concurrent, and continued stay authorizations for patient treatment services.
• Utilize ASAM criteria and DSM-5 diagnostic criteria to determine medical necessity and appropriate levels of care.
• Assess treatment progress and support continued stay recommendations.
• Identify high-risk, complex, or denial-prone cases and collaborate with clinical leadership to address barriers to care.
• Partner with therapists, providers, and interdisciplinary teams to gather and communicate clinical information.
• Maintain accurate, timely, and compliant documentation of all utilization review activities.
• Track authorization status and ensure payer deadlines and requirements are met.
• Assist with appeals, reconsiderations, and denial management activities.
• Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
• Participate in quality improvement efforts related to utilization management and reimbursement processes.

Licensed Behavioral Health Professional

Position Summary

The Utilization Review / Utilization Management Coordinator is responsible for coordinating authorization and reimbursement activities to ensure patients receive appropriate levels of care throughout treatment. This position works collaboratively with Intake, Clinical Services, Medical Records, Business Office, Nursing, and Providers to communicate clinical information to payers and obtain authorization for services.

The ideal candidate is a licensed behavioral health professional with experience in mental health treatment, a strong understanding of ASAM criteria, and the ability to effectively advocate for patients with insurance providers.

Qualifications

Required:

• Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or a related behavioral health field.
• Current state licensure as one of the following:
  • Licensed Clinical Social Worker (LCSW/LICSW)
  • Licensed Mental Health Counselor (LMHC)
  • Licensed Professional Counselor (LPC)
  • Licensed Marriage & Family Therapist (LMFT)
  • Other equivalent independent behavioral health license
• Two (2) years of experience in behavioral health and/or substance use disorder treatment.
• Working knowledge of ASAM criteria and DSM-5.
• Strong clinical assessment, documentation, and communication skills.
• Proficiency with electronic health records and Microsoft Office applications.

Preferred:

• Previous Utilization Review, Utilization Management, Case Management, or Insurance Authorization experience.
• Experience in inpatient, residential, PHP, IOP, treatment settings.
• Knowledge of managed care and commercial insurance requirements.