Utilization Review Coordinator

Northbrook Behavioral Health Hospital; Gloucester City (NJ); On-site; USD 60,000 - 85,000; Full time

Job summary

Northbrook Behavioral Health Hospital is seeking an Utilization Review Coordinator to oversee the clinical review process for inpatient psychiatry, ensuring medical necessity and timely authorizations while maximizing reimbursement. The role collaborates with providers, nursing and social work to maintain payer-compliant documentation.

This onsite position (Mon-Fri, first shift) liaises with payers to promote quality care and financial stewardship throughout hospitalization, discharge planning,

Qualifications

• RN or behavioral health clinician preferred.
• Bachelor's degree required.
• 3+ years inpatient behavioral health experience.
• Experience with utilization review, discharge planning, or managed care preferred.
• Experience with commercial insurance, Medicare, Medicaid, and managed care authorization.

Responsibilities

• Coordinate the clinical review process to ensure appropriate inpatient psychiatric service utilization and maximize reimbursement.
• Serve as liaison between hospital and insurance payers to meet medical necessity and payer requirements.
• Collaborate with providers, nursing, and social work to ensure documentation supports payer requirements throughout hospitalization.
• Assist with discharge planning and concurrent reviews to promote timely authorizations and efficient care.

Skills

Communication skills

Organizational skills

Time management

Multitasking

EMR proficiency

Team collaboration

Education

Bachelor's degree

RN or behavioral health clinician preferred

Tools

EMR systems

Job description

The Utilization Review (UR) Coordinator is responsible for coordinating the clinical review process to ensure appropriate utilization of inpatient psychiatric services while maximizing reimbursement through timely authorization, concurrent review, and denial prevention. Working collaboratively with providers, nursing, and social work, the UR Coordinator ensures patients meet medical necessity criteria throughout their hospitalization, and documentation supports payer requirements.

This position serves as a key liaison between the hospital and insurance payers to promote quality patient care, regulatory compliance, and financial stewardship.

*This position is onsite in the office Monday through Friday (1st shift)*

Education

• Registered Nurse or other qualified behavioral health clinician strongly preferred.

• Bachelor's degree required.

Experience

• 3+ years of inpatient behavioral health experience.

• Previous utilization review, case management, discharge planning, or managed care experience are strongly preferred.

• Experience with commercial insurance, Medicare, Medicaid, and managed care authorization processes.

Knowledge, Skills, and Abilities

• Strong understanding of behavioral health medical necessity criteria (MCG preferred).

• Knowledge of psychiatric documentation standards and payer expectations.

• Experience conducting concurrent reviews and communicating effectively with insurance reviewers.

• Excellent clinical assessment and critical thinking skills.

• Strong verbal and written communication abilities.

• Exceptional organizational and time management skills.

• Ability to manage multiple payer deadlines simultaneously.

• Proficiency with electronic medical records.

• Strong collaboration and team building skills with interdisciplinary teams.