Lead Utilization Review Coordinator

Acadia • Chandler, AZ

1d

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 serves as a liaison between managed care organizations and the facility’s professional clinical staff, coordinates communications about reimbursement requirements, reviews medical necessity and services provided, and supports pre-certification, appeals, and staff training related to utilization requirements.

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.
• De-escalation and restraint certification; training is available upon hire and offered by the facility.

Nice To Haves

• Previous experience in utilization management.
• LMSW, LCSW, LPC, LAC, or another current clinical professional license or certification required within the state where the facility provides services.
• First aid, if required by state or facility requirements.

Responsibilities

• Act as liaison between managed care organizations and the facility’s professional clinical staff.
• Conduct reviews in accordance with certification requirements for insurance plans and other managed care organizations, and coordinate communications 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 reports 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 formal appeals for denied admissions or continued stays.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing staff support and training on documentation and charting requirements, continued-stay criteria, and medical necessity updates.
• Perform other functions and tasks as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior