Lead Utilization Review Coordinator

Acadia Healthcare•Chandler, AZ

14h

About The Position

The Lead Utilization Review Coordinator proactively monitors utilization of services for patients to optimize facility reimbursement and provides backup coverage to the UR Director. The role liaises between managed care organizations and facility professional clinical staff, conducts utilization reviews in accordance with certification requirements, and coordinates communication about reimbursement requirements. It monitors patient length of stay and extensions, communicates issues that may affect length of stay, and supports admissions with pre-certifications of care. The coordinator also conducts medical necessity and service quality reviews, facilitates peer review calls, manages formal appeals for denied admissions or continued stays, prepares utilization-related reports, and provides staff support and training on documentation, continued-stay criteria, and medical necessity updates.

Requirements

Master’s degree in Social Work, Behavioral or Mental Health, or a related health field.
Clinical experience, or at least two years of experience working with the facility’s population.
CPR certification required.
De-escalation and restraint certification required; training is available upon hire and offered by the facility.
First aid may be required based on state or facility requirements.

Nice To Haves

Previous experience in utilization management is preferred.
Preferred licensure: LMSW, LCSW, LPC, or LAC within the state where the facility provides services, or a current clinical professional license or certification required in that state.

Responsibilities

Act as liaison between managed care organizations and facility professional clinical staff.
Conduct reviews in accordance with certification requirements for insurance plans or other managed care organizations, and coordinate communication concerning reimbursement requirements.
Monitor patient length of stay and extensions, and inform clinical and medical staff about issues that may affect length of stay.
Gather and develop statistical and narrative information on utilization, non-certified days and their causes, appeal information, discharges, and quality of services, as required by facility leadership or the corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between the facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stays.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training to staff on documentation or charting requirements, continued-stay criteria, and medical necessity updates.
Provide backup coverage to the UR Director.
Perform other functions and tasks as assigned.