Utilization Review Coordinator

MN Adult and Teen Challenge•Minneapolis, MN

20h•$27 - $30•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 submits and tracks initial, concurrent, continued-stay, and reauthorization requests; communicates authorization determinations and payer requirements; and coordinates with clinical staff to obtain documentation supporting medical necessity and level-of-care recommendations. It reviews documentation against payer requirements, ASAM Criteria, and utilization review standards, and helps clinical staff strengthen documentation. The coordinator also serves as a payer liaison, supports denial management and appeals, documents authorization activities in the electronic health record and tracking systems, monitors outcomes and trends, and contributes to quality improvement and coordination across admissions, clinical, and revenue cycle functions. The role requires compliance with HIPAA, 42 CFR Part 2, Minnesota Department of Human Services requirements, payer regulations, and organizational policies. Initial training takes place 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 may be required.

Requirements

High school diploma or GED required.
At least two years of experience in utilization review, admissions, healthcare reimbursement, insurance authorization, behavioral health, or a related healthcare setting.
Experience using electronic health records.
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, including mental health issues and addiction.
Demonstrate MnTC's mission, Culture of Honor, core values, and Putting Honor in Action principles through daily interactions, fostering a welcoming, respectful, relationship-centered environment.
At least one year of freedom from problematic substances.
Successfully complete and maintain all required training and competency requirements applicable to the position before providing direct care or client services, including training related to client rights, confidentiality, mandated reporting, professional boundaries, and applicable licensing and regulatory requirements.
Successfully complete a Minnesota Department of Human Services background study and maintain eligibility for applicable DHS background studies, clearances, and requirements before providing direct care or client services.
Able to sit for prolonged periods and work on a computer; frequently use a telephone, headset, and computer systems throughout the workday; and occasionally lift up to 10 pounds.

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 with Credible or a similar electronic medical record 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 initiate renewal requests proactively 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 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 between the organization and third-party payers regarding authorization requests, continued care reviews, and related inquiries.
Monitor authorization outcomes and identify trends, barriers, or 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.