Lead Utilization Review Coordinator

Oasis Behavioral Health • Chandler, AZ

2d

About The Position

The Lead Utilization Review Coordinator proactively monitors utilization of services for patients to optimize reimbursement for the facility and provides backup coverage to the UR Director. The role liaises between managed care organizations and facility professional clinical staff, conducts utilization and quality reviews, and coordinates communication concerning reimbursement requirements. It also supports admissions pre-certifications, formal appeals, and staff 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 two or more years of experience working with the facility’s population.
• CPR and de-escalation and restraint certification are 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.
• LMSW, LCSW, LPC, or LAC licensure 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 identified 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 staff support and training on documentation or charting requirements, continued-stay criteria, and medical-necessity updates.
• Perform other functions and tasks as assigned.
• Provide backup coverage to the UR Director.

What This Job Offers

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