Utilization Review Coordinator

Bradford Health Services; Warrior (AL); Remote; USD 40,000 - 70,000; Full time

Job summary

An established industry player in healthcare is seeking dedicated professionals for a remote entry-level position in utilization review. This role involves coordinating insurance certifications and conducting thorough reviews while ensuring compliance with confidentiality regulations. Candidates should possess strong communication skills and a current RN or relevant license, alongside experience in utilization review. Join a supportive team where your contributions will make a significant impact on patient care and operational efficiency. If you are passionate about healthcare and ready to grow in a dynamic environment, this opportunity is perfect for you.

Qualifications

• Preferred current RN, LPC, LMFT, LMSW, or LCSW license.
• Two years minimum experience in utilization review is preferred.

Responsibilities

• Coordinate insurance certification, including precertification and continued stay reviews.
• Maintain UR Activity Log and document reviews in electronic records.

Skills

Grammatical Skills

Communication Skills

Microsoft Office

Education

RN License

LPC License

LMFT License

LMSW License

LCSW License

Tools

Patient Electronic Record Software

Job description

Full-Time Remote

Entry Level Qualifications

A current RN, LPC, LMFT, LMSW, or LCSW license is preferred. Two years minimum experience in utilization review is preferred. Must possess good grammatical and communication skills. Must be skilled in Microsoft Office applications and have a working knowledge of office equipment.

• Must be able to read and comprehend hand-written, printed, and online treatment notes and plans.
• Must be able to hear and comprehend conversations and instructions.
• Must be able to continuously sit for approximately 7 hours per 8-hour shift.
• Must be able to walk within the facility for a total of approximately two (2) hours per day.
• If recovering, two years of continuous verifiable abstinence.

General Responsibilities

Complete coordination of the facility's insurance certification, including precertification, continued stay reviews, and follow-up on all insurance denials, appeals, and reconsiderations.

Know and abide by the general provisions of 42 CFR Part 2, “Confidentiality of Drug and Alcohol Abuse Patient Records,” and 45 CFR, “Health Insurance Portability and Accountability Act.” This position has unrestricted access to patient identifying and health information.

Essential Functions

• Perform all pre-admission certification reviews, continued stay reviews, appeals, denials, and/or reconsiderations, providing information to the appropriate review agency or insurance company.
• Maintain a "UR Activity Log" recording every review for the facility with financial classification and utilization review information/activity.
• Maintain a "call back" calendar for continued stay reviews and a utilization review file for each patient.
• Document reviews in the patient electronic record software, including the level of care requested, status, outcome, and next review information.
• Review and maintain all correspondence related to certification, appeals, denials, or reconsiderations, ensuring they are scanned into the patient electronic health record.
• Complete all Quality Improvement indicators for Utilization Management, including data analysis and reporting.
• Educate counseling staff on the data needed to adequately document patient care and educate crisis staff on documentation for intake assessments and managed care criteria.
• Ability to work in a constant state of alertness to perform the job safely.
• Work cooperatively with co-workers, managers, clients, and prospective managers.
• Maintain regular attendance.
• Perform any other duties as assigned by the supervisor.