Utilization Review (UR) / Utilization Management (UM) Coordinator

Universal Hospital Services Inc.; Moultrie (GA); On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

Competitive compensation

Generous Paid Time Off

Excellent Medical, Dental, Vision

Job summary

Turning Point Care Center is seeking a Utilization Review/Utilization Management Coordinator to oversee care continuity and reimbursement. You will conduct concurrent and extended reviews, monitor treatment plans, and liaise with insurance providers and the care team to ensure compliance and optimal outcomes.

Qualifications include RN/LMSW/LAPC/LAMFT and experience with utilization review, medical terminology, and varied insurance plans.

Qualifications

• Licensed through state board for Nursing or Counseling/Therapy.
• Experience with utilization review and clinical terminology.
• Understanding of insurance plans and medical necessity criteria.

Responsibilities

• Conduct concurrent and extended-stay reviews using ASAM criteria and DSM-5 guidelines.
• Collaborate with Admissions, Clinical Staff, Nursing, Medical Records, and Business Office.
• Review patient records, treatment plans, and clinical status; communicate third-party requirements.
• Perform clinical reviews with insurance case managers by telephone and electronically.
• Maintain documentation in MIDAS and other UGMS records; run reports as needed.
• Prepare and submit timely appeals to third-party payors with the team.
• Attend treatment team and AR/Denials meetings and maintain records.

Skills

Chart analysis

Utilization review

Medical terminology

Acuity of illness

Education

RN, LMSW, LAPC, or LAMFT required

BSN, MSN, LCSW, LPC, or LMFT preferred

Tools

MIDAS

Job description

Responsibilities

Utilization Review (UR) / Utilization Management (UM) Coordinator Opportunity

Turning Point Care Center provides comprehensive behavioral health care for adults experiencing chemical dependency, acute psychiatric disorders, or a dual diagnosis. For more than 40 years, our team has provided a place of healing and hope through a full continuum of inpatient and outpatient care, with programs tailored to meet each patient’s unique needs.

Nestled in a serene, rural setting in Moultrie, Georgia, Turning Point offers a calming, secure environment where patients can focus on recovery and build a foundation for lifelong wellness. Our commitment to quality care is grounded in the belief that healthy communities begin with healthy individuals and strong connections to family, friends, and peers.

Centrally located in South Georgia, our facility is just 30 minutes from I-75, 1.5 hours north of Tallahassee, 3 hours south of Atlanta, and 2.5 hours west of Jacksonville. Turning Point offers a rewarding opportunity to build a career while making a meaningful difference in the lives of those we serve.

Visit the site virtually: turningpointcare.com

The Utilization Review / Utilization Management Coordinator oversees utilization management functions to monitor the appropriateness and continuity of patient care while optimizing reimbursement. This position conducts clinical reviews, monitors patient records and treatment plans, communicates with insurance providers and treatment team members, and ensures compliance with applicable requirements.

Job Duties/Responsibilities

• Conduct concurrent and extended-stay reviews using ASAM criteria and DSM-5 guidelines to determine medical necessity, appropriateness of care, continued stay, and discharge criteria
• Collaborate with Admissions, Clinical Staff, Nursing, Medical Records, Business Office, and providers to address insurance issues and communicate patient information and benefits
• Review patient records, treatment plans, and clinical status; communicate pertinent third-party payor requirements and acuity concerns to physicians and the treatment team
• Perform clinical reviews with insurance case managers by telephone and electronically while maintaining positive working relationships with third-party payors
• Maintain accurate and timely documentation in MIDAS and other Utilization Management records; run and interpret reports as needed
• Prepare and submit timely appeals to third-party payors, working with the Business Office and treatment team to gather supporting documentation
• Attend treatment team and AR/Denials meetings and maintain records in accordance with applicable policies, regulatory requirements, and accreditation standards

Benefit & Rewards Highlights

• Challenging and rewarding work environment
• Competitive compensation & generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Tuition saving to continue your nursing education with Chamberlain University
• Career development opportunities within UHS and its 300+ Subsidiaries!
• Pet Insurance
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network, and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico, and the United Kingdom. For additional information visit www.uhs.com.

From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

Qualifications

Requirements

• Licensed through state board for Nursing or Counseling/Therapy
  • RN, LMSW, LAPC, or LAMFT required; BSN, MSN, LCSW, LPC, or LMFT preferred
• Three years’ experience in chart analysis, utilization review, medical/clinical terminology, and acuity of illness
• Knowledge and understanding of a variety of insurances including Traditional Medicare, Medicare Advantage Plans, and Commercial Plans
• Knowledge and experience with chemical dependency and mental health programs, situa itional evalua tions, and crisis intervention preferred

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.