Utilization Review (UR) / Utilization (UM) Coordinator

Turning Point Care Center; Moultrie (GA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Life Insurance

Flexible Spending Accounts

Health Savings Accounts

Short and Long Term Disability

401K with match

Employee Stock Purchase Plan

Discounted benefits

Job summary

Turning Point Care Center in Georgia seeks an Utilities Review/Management Coordinator to coordinate patient information with insurers for benefits and to perform clinical reviews by phone and electronically.

Ideal candidates hold RN, LMSW, LAPC, or LAMFT licensure with at least 3 years of chart analysis and utilization review experience, plus knowledge of Medicare and commercial plans. Experience in chemical dependency and mental health programs is preferred.

Qualifications

• Active state licensure (nursing or counseling/therapy).
• Minimum 3 years in chart analysis, utilization review, medical terminology, and acuity of illness.
• Knowledge of Traditional Medicare, Medicare Advantage, and Commercial Plans.
• Experience with chemical dependency and mental health programs preferred.

Responsibilities

• Coordinate and communicate patient information to insurers for benefits assignment.
• Perform clinical reviews over the telephone and electronically.
• Apply ASAM criteria (DSM-V) to determine admission, continued stay, and discharge criteria.
• Maintain records to comply with accrediting and regulatory requirements.

Skills

Chart analysis

Utilization review

Medical terminology

Acuity of illness

Education

RN

LMSW

LAPC

LAMFT

Job description

Responsibilities

• The Utilization Review / Utilization Management Coordinator works closely with staff from 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

• 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.

Opportunity Offers

• CEUs required for biannual licensure for Therapists (provided for free without having to use leave to attend)
• Rewarding work environment
• Growth and Development Opportunities within UHS and its 300+ subsidiaries
• Excellent Medical, Dental, Vision and Prescription Drug Plan
• 401k plan with company match and discounted stock plan
• SoFi Student Loan Refinancing Program

Location

Centrally located in South Georgia, our facility is 30 minutes from I-75, 1.5 hours north of Tallahassee, FL, 3 hours south of Atlanta, GA, and 2.5 hours west of Jacksonville, FL. Employees reside in Moultrie or surrounding communities including Albany, Tifton, Thomasville, and Valdosta, GA.

Application Information

Apply online at https://jobs.uhsinc.com/turning-point-care-center

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.