Utilization Management & Clinical Therapist – Residential

San Marcos Treatment Center; San Marcos (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

San Marcos Treatment Center, located on 63 acres in the Texas hill country and known nationwide for programming for children and adolescents in a residential setting, seeks a Utilization Management Coordinator to facilitate a continuum of service, promote positive outcomes, and optimize reimbursement through coordination of patient care, reviews, and reporting.

The role includes managing preauthorizations, UR processes, documentation, and collaboration with hospital staff while maintaining

Qualifications

• Extensive knowledge of behavioral health systems and Utilization Management required.
• Two years of UR experience in a hospital or healthcare insurance setting required.
• Texas LPC, LMHC, LCSW, LCPC or LPCC or LMSW

Responsibilities

• Obtain preauthorization for admissions and continued stays within one business day where required.
• Manage retrospective authorizations and denials/appeals processes.
• Timely communication of preauthorization outcomes to hospital staff and patients.
• Document activity in Billing and UR software and prepare reports for meetings.
• Organize and file documents for easy access in approved locations.
• Assist in compiling data for analysis related to preauthorization and reimbursement.
• Assist hospital staff in determining insurance coverage likelihood for treatment.
• Maintain patient confidentiality per state and federal law.
• Participate in in-service education, performance improvement, and compliance activities.
• Promote service excellence and manage difficult patient discussions professionally.
• Provide direct behavioral healthcare services to children/adolescents in residential treatment as needed.

Skills

Utilization Management

Preauthorization

UR Experience

Behavioral Health

Education

Texas LPC, LMHC, LCSW, LCPC or LPCC or LMSW

Tools

Billing software

UR software

Job description

San Marcos Treatment Center, located on 63 acres in the Texas hill country and known nationwide for programming for children and adolescents in a residential setting, seeks a Utilization Management Coordinator to facilitate a continuum of service, promote positive outcomes, and optimize reimbursement through coordination of patient care, reviews, and reporting.

The role includes managing preauthorizations, UR processes, documentation, and collaboration with hospital staff while maintaining