The Utilization Review Coordinator conducts continued stay reviews of medical record documentation using pre-established criteria and provides updated progress reports to third party payers in order to receive certification for payment. He or she must be client focused, team oriented, dependable, and focused on compliance and performance quality with great interpersonal and communication skills. In addition, he or she must be flexible to sudden changes in workload, emergencies, or staffing and have good problem solving skills.

The ideal candidate for this position has Bachelor's degree (BA) in Behavioral Health, Master's Degree preferred with 1 year of direct drug and alcohol, billing and previous utilization review experience. He or she must be proficient in Microsoft Office, have strong organization skills, and be able to make decisions and work independently. Knowledge of facility systems and organization as they pertain to medical records and organization review and knowledge of medical terminology and medical record format and content required.

RESPONSIBILITIES

Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized, and authorization numbers

Performs concurrent continued stay reviews using pre-established criteria, understands ASAM criteria, and communicates this information accurately to insurance carriers

Consults with appropriate treatment team members for clarification of documentation as needed

Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals and inputs data accurately for financial purposes

Maintains accurate review sheets of all reviews performed

Helps supervisor and departments identify patterns of mis-utilization

Responds to telephone messages quickly, professionally, and appropriately

Participates in continuing education to reach professional growth objectives by attending in-services and other training opportunities

Participates in task forces and committees as assigned

Attends case conference for clinical updates

Maintains and communicates authorization information to all team members

Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required

Educates new staff members about ASAM criteria, high-quality documentation, and insurance needs

Works in an environment with risk of exposure to communicable disease and possible exposure to intoxicated, disruptive, and/or agitated patients

Performs other duties as assigned

Qualification

Bachelor's degree (BA) in Behavioral Health required, Master's Degree preferred with 1 year of direct drug and alcohol experience, billing and previous utilization review experience.

Knowledge of 12-step recovery and an understanding of chemical dependency

Knowledge of facility systems and organization as they pertain to medical records and organization review

Knowledge of medical terminology and medical record format and content

Excellent computer, internet, and business software skills

Excellent customer-facing and phone skills

Communication and interpersonal skills to develop relationships with patients, staff, and providers

Strong organization skills with a proven ability to multi-task and manage time to meet frequently changing deadlines in a fast-paced environment