Utilization Review Coordinator

MnTC•Minneapolis, MN

1d•Hybrid

About The Position

The Utilization Review Coordinator obtains and maintains insurance authorizations for treatment services, partnering with admissions, counselors, clinical leadership, payers, and other internal stakeholders. The role supports timely authorization of services, medical necessity determinations, continued stay reviews, and compliance with payer, regulatory, and organizational requirements. The position is hybrid during initial training, which is completed in person in Minneapolis. After successful completion of training, the position is primarily remote unless business needs require onsite attendance. Occasional travel to MnTC locations for meetings, training, or other business purposes may be required. The role requires a high school diploma or GED and at least two years of experience in utilization review, admissions, healthcare reimbursement, insurance authorization, behavioral health, or a related healthcare setting. An associate's or bachelor's degree, LADC credentials, and experience or knowledge in behavioral healthcare and utilization review are preferred. Target compensation is $27.00–$30.00 per hour, negotiable based on qualifications.

Requirements

High school diploma or GED.
Two years of experience in utilization review, admissions, healthcare reimbursement, insurance authorization, behavioral health, or a related healthcare setting.
At least one year of freedom from problematic substances.
Strong organizational, time management, communication, and problem-solving skills.
Ability to manage multiple priorities, work independently, and collaborate effectively with internal and external stakeholders.
Ability to maintain confidentiality, exercise sound judgment, and accurately document and communicate information.
Comfort and compassion in working with individuals facing life-controlling challenges, such as mental health issues and addiction.
Ability to successfully complete and maintain required position-specific training and competencies, including training related to client rights, confidentiality, mandated reporting, professional boundaries, and applicable licensing and regulatory requirements.
Ability to successfully complete and maintain eligibility for a Minnesota Department of Human Services background study and other applicable clearances and requirements.
Ability to sit for prolonged periods and work on a computer; frequently use a telephone, headset, and computer systems; and occasionally lift up to 10 pounds.
Ability to attend in-person initial training in Minneapolis and occasional travel to MnTC locations for meetings, training, or other business purposes.

Nice To Haves

Associate's or bachelor's degree in healthcare, behavioral health, human services, business, or a related field.
Licensed Alcohol and Drug Counselor (LADC) credentials.
Experience in substance use disorder treatment, mental health services, or other behavioral healthcare settings.
Knowledge of DSM-5-TR, ASAM Criteria, insurance authorization processes, medical necessity standards, and third-party payer requirements.
Experience using electronic health records, preferably Credible or a similar EMR system.

Responsibilities

Obtain and maintain insurance authorizations for treatment services in accordance with payer requirements and organizational policies.
Submit initial authorization requests, continued stay reviews, concurrent reviews, and reauthorization requests accurately and within required timelines.
Monitor authorization status and periods, and proactively initiate renewal requests to prevent interruptions in client care and coverage.
Communicate authorization determinations, benefit information, and payer requirements to clinical and operational team members.
Collaborate with counselors, nursing staff, providers, and clinical leadership to obtain documentation supporting medical necessity and level-of-care recommendations.
Review clinical documentation for alignment with payer requirements, ASAM Criteria, and other applicable utilization review standards.
Assist clinical staff in strengthening documentation for authorization requests, continued stay reviews, and medical necessity determinations.
Maintain working knowledge of third-party payer requirements, authorization processes, reimbursement guidelines, and industry best practices related to substance use disorder treatment.
Serve as a liaison with third-party payers regarding authorization requests, continued care reviews, and related inquiries.
Monitor authorization outcomes and identify trends, barriers, and opportunities for process improvement.
Document authorization activity, payer communication, and utilization review outcomes in the electronic health record and designated tracking systems.
Participate in interdisciplinary treatment team meetings as needed to support authorization and utilization review activities.
Assist with denial management, appeals, and payer requests for additional information as assigned.
Maintain compliance with HIPAA, 42 CFR Part 2, Minnesota Department of Human Services requirements, payer regulations, and organizational policies and procedures.
Support departmental quality improvement initiatives and coordination between admissions, clinical, and revenue cycle functions.
Demonstrate MnTC's mission, Culture of Honor, core values, and Putting Honor in Action principles in daily interactions.
Complete and maintain required training and competency requirements before providing direct care or client services.
Complete a Minnesota DHS background study and maintain eligibility for applicable background studies, clearances, and requirements before providing direct care or client services.