UR Coordinator

San Antonio Behavioral Healthcare Hospital • San Antonio, TX

2h • Onsite

About The Position

We are seeking a Utilization Review (UR) Coordinator to join our team. The UR Coordinator is a healthcare professional who bridges the gap between medical providers, patients, and insurance companies. They evaluate medical records to ensure that patient treatments meet established clinical guidelines, secure insurance authorizations, and manage healthcare costs while maintaining quality care.

Requirements

• Highschool Diploma/GED required.
• Must possess or obtain a valid CPR certification and de-escalation training before completing new hire orientation.
• Exceptional verbal and written skills to translate complex insurance rules to therapists, psychiatrists, and families
• Ability to review complex medical records to extract data that proves medical necessity
• Strong negotiation skills to defend treatment plans during difficult conversations with insurance medical directors
• Organizational skills
• Proven expertise solving problems
• Proficiency in Microsoft Office Suite and other related software to perform necessary tasks

Nice To Haves

• Bachelor’s degree preferred.
• Experience in behavioral healthcare preferred.

Responsibilities

• Submitting clinical documentation to health insurance to approve planned procedures, hospital admissions, or continued stays
• Reviewing patient charts to ensure the level of care matches the patient's condition and meets both regulatory and insurance standards
• Ensuring all medical documentation adheres to HIPAA and insurance regulations
• Acting as a central point of contact between clinical staff, billing departments, and third-party payers
• Attending interdisciplinary treatment team to gather clinical justifications, track therapy progress, and align care plans with approved insurance days
• Monitoring how long patients stay in the facility against approved insurance timelines to reduce financial penalties
• Advising the clinical team on what documentation is missing or needed to justify continued care to the insurance company
• Reviewing insurance denial letters to pinpoint the exact contractual or clinical reason why the level of care was rejected
• Scheduling and preparing facility psychiatrists for immediate telephonic reviews with insurance medical directors
• Drafting and submitting urgent clinical appeal packets within tight, state-mandated 24 to 72-hour windows for active patients
• Perform other duties as per the requirements of the organization.

Benefits

• 401K
• Medical/Dental insurance
• FMLA
• Short-Term Disability
• Health Insurance
• Vision Insurance
• Dental Insurance
• 401K Retirement Plan
• Healthcare Spending Account
• Dependent Care Spending Account
• PTO Plan with Holiday Premium Pay
• Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
• Short and Long-Term Disability (with additional buy-in opportunities)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED