Utilization Review Coordinator

MN Adult & Teen Challenge; Minneapolis (MN); Hybrid; USD 37,000 - 41,000; Full time

Job summary

Minnesota Adult & Teen Challenge is seeking an Utilization Review Coordinator to manage insurance authorizations for treatment services. This role collaborates with admissions, counselors, and payers to ensure timely authorizations and compliance with payer and regulatory standards.

Responsibilities include submitting authorization requests, monitoring status, and guiding documentation to support medical necessity and level of care. Must stay current with payer rules and HIPAA compliance.

Qualifications

• Two years of experience in utilization review, admissions, healthcare reimbursement, insurance authorization, behavioral health, or related healthcare setting.
• Knowledge of DSM-5-TR, ASAM Criteria, and payer requirements preferred.
• Must complete DHS background study and maintain eligibility.

Responsibilities

• Obtains and maintains insurance authorizations for treatment services.
• Submits initial authorization requests, continued stay reviews, and reauthorization requests.
• Monitors authorization status and initiates renewals to prevent interruptions in care.
• Communicates determinations and payer requirements to clinical and operational teams.
• Collaborates with counselors, nursing staff, and leadership to support medical necessity.

Skills

Utilization review

Insurance authorization

Healthcare reimbursement

Behavioral health

DSM-5-TR knowledge

Credible EMR

One year sobriety

Strong communication

Organizational skills

Education

Associate's or Bachelor's degree in healthcare

High school diploma or GED

Tools

Credible EMR

Job description

3231 1st Avenue
Minneapolis, MN 55408, USA

Description

Be the backbone of hope and healing.
At Minnesota Adult & Teen Challenge, every role matters in helping people overcome addiction and find a new path forward. Whether you’re working directly with clients or supporting behind the scenes, your contributions make recovery possible. In return, we offer a values-driven workplace, supportive managers, and opportunities to grow. That commitment has earned us recognition from Newsweek as a Best Addiction Treatment Center and seven straight Star Tribune Top Workplace awards.

Job Summary

The Utilization Review Coordinator is responsible for obtaining and maintaining insurance authorizations for treatment services. This position partners closely with admissions, counselors, clinical leadership, payers, and other internal stakeholders to ensure timely authorization of services, support medical necessity determinations, facilitate continued stay reviews, and promote compliance with payer, regulatory, and organizational requirements.

• Obtains and maintains insurance authorizations for treatment services in accordance with payer requirements and organizational policies.
• Submits initial authorization requests, continued stay reviews, concurrent reviews, and reauthorization requests accurately and within required timelines.
• Monitors authorization status, tracks authorization periods, and proactively initiates renewal requests to prevent interruptions in client care and coverage.
• Communicates authorization determinations, benefit information, and payer requirements to appropriate clinical and operational team members.
• Collaborates with counselors, nursing staff, providers, and clinical leadership to obtain documentation necessary to support medical necessity and level of care recommendations.
• Reviews clinical documentation to ensure alignment with payer requirements, ASAM Criteria, and other applicable utilization review standards.
• Assists clinical staff in strengthening documentation to support authorization requests, continued stay reviews, and medical necessity determinations.
• Maintains a working knowledge of third-party payer requirements, authorization processes, reimbursement guidelines, and industry best practices related to substance use disorder treatment.
• Serves as a liaison between the organization and third-party payers regarding authorization requests, continued care reviews, and related inquiries.
• Monitors outcomes of authorization requests and identifies trends, barriers, or opportunities for process improvement.
• Accurately documents authorization activity, payer communication, and utilization review outcomes within the electronic health record and other designated tracking systems.
• Participates in interdisciplinary treatment team meetings as needed to support authorization and utilization review activities.
• Assists with denial management, appeals, and requests for additional information from payers as assigned.
• Maintains compliance with HIPAA, 42 CFR Part 2, Minnesota Department of Human Services requirements, payer regulations, and organizational policies and procedures.
• Supports departmental quality improvement initiatives and contributes to effective coordination between admissions, clinical, and revenue cycle functions.

Required Skills & Experience (Minimum Qualifications):

• High school diploma or GED required; Associate's or Bachelor's degree in healthcare, behavioral health, human services, business, or a related field preferred.
• Two years of experience in utilization review, admissions, healthcare reimbursement, insurance authorization, behavioral health, or a related healthcare setting required.
• Licensed Alcohol and Drug Counselor (LADC) credentials preferred but not required.
• Experience in substance use disorder treatment, mental health services, or other behavioral healthcare settings preferred.
• Knowledge of DSM-5-TR, ASAM Criteria, insurance authorization processes, medical necessity standards, and third-party payer requirements preferred.
• Experience using electronic health records, preferably Credible or a similar EMR system.
• Strong organizational, time management, communication, and problem-solving skills with the ability to manage multiple priorities, work independently, and collaborate effectively with internal and external stakeholders.
• Ability to maintain confidentiality, exercise sound judgment, and accurately document and communicate information.
• Comfort and compassion in working with individuals facing life-controlling challenges, such as mental health issues and addiction.
• Demonstrate MnTC's mission, Culture of Honor, core values, and Putting Honor in
• Action principles through daily interactions, fostering a welcoming, respectful, and relationship centered environment.
• At least 1 year of freedom from problematic substances.
• Must successfully complete and maintain all required training and competency requirements applicable to the position prior to providing direct care or client services, including training related to client rights, confidentiality, mandated reporting, professional boundaries, and other applicable licensing and regulatory requirements.
• Must successfully complete a Minnesota Department of Human Services (DHS) background study and maintain eligibility for all DHS background studies, clearances, and requirements applicable to assigned services and programs prior to providing direct care or client services.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Frequent use of a telephone, headset, and computer systems throughout the workday.
• Must be able to lift up to 10 pounds occasionally.
• Initial training is completed in person in Minneapolis. Following successful completion of training, this position is primarily remote unless business needs require onsite attendance.
• Occasional travel to MnTC locations for meetings, training, or other business purposes may be required.

Target Compensation (Negotiable based on Qualifications):

$27.00-$30.00/hour

We seek to recruit, develop and retain the most talented people from a diverse candidate pool in order to successfully meet our mission of helping every Minnesotan find help and healing from addiction.

Mn Adult & Teen Challenge is an Equal Opportunity Employer and does not discriminate based on any category protected by federal, state or applicable laws.

Reasonable accommodation is provided upon request.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.