Utilization Review (UR) / Utilization (UM) Coordinator

Universal Health Services; Moultrie (GA); On-site; USD 60,000 - 85,000; Full time

Job summary

Universal Health Services in Georgia is seeking a licensed professional to serve as Utilization Review / Utilization Management Coordinator. The role collaborates with clinical and administrative staff to coordinate patient information and communicate with insurers for benefits assignment.

Responsibilities include conducting clinical reviews by phone and electronically, applying ASAM criteria (DSM-V) to determine admission and discharge criteria, and ensuring records comply with accrediting and

Qualifications

• Licensure through state board for nursing or counseling/therapy.
• Three (3) years of experience in chart analysis, utilization review, medical/clinical terminology, and acuity of illness.
• Knowledge of Traditional Medicare, Medicare Advantage Plans, and Commercial Plans.
• Knowledge/experience with chemical dependency programs, mental health programs, situational evaluations, and crisis intervention (preferred).

Responsibilities

• Performs clinical reviews over the telephone and electronically.
• Utilizes ASAM criteria (DSM-V) to determine appropriateness of admission, continued stay, discharge criteria and identifies high‑risk cases.
• Adheres to accrediting and regulatory agency requirements in maintaining records to ensure compliance.

Skills

Chart analysis

Utilization review

Medical terminology

Acuity of illness

Crisis intervention

Education

RN license

Counseling/therapy license (LMSW/LPC/LCSW/LAMFT)

Job description

Responsibilities

Utilization Review / Utilization Management Coordinator (Licensed Therapist or RN)

The Utilization Review / Utilization Management Coordinator works closely with the other staff of Utilization Review/Management, Intake, Business Office, Medical Records, Clinical Staff, Nursing, and providers to coordinate and communicate patient information to insurance companies for the assignment of benefits.

• Performs clinical reviews over the telephone and electronically.
• Utilizes ASAM criteria (DSM-V) to determine appropriateness of admission, continued stay, discharge criteria and identifies high‑risk cases.
• Adheres to accrediting and regulatory agency requirements in maintaining records to ensure compliance.

Qualifications

• Licensure through state composite board for nursing or counseling/therapy:
  • Minimum RN, LMSW, LAPC, LAMFT
  • Preferred BSN, MSN, LCSW, LPC, LMFT
• Three (3) years of 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 programs, mental health programs, situational evaluations, and crisis intervention, preferred.

Benefits

We offer a competitive and comprehensive benefits program including:

• Medical
• Dental
• Vision
• Life Insurance
• Flexible Spending Accounts
• Health Savings Accounts
• Short and Long Term Disability
• 401K with match
• Employee Stock Purchase Plan
• and additional voluntary benefits and discounts. (Even Pet Insurance!!)

Additional benefit details provided at https://benefits.uhsguest.com . Choose “I am a Guest” to view options designed to enhance and promote our employees’ health and wellbeing.

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.