Utilization Review Coordinator

Axiom Care • Phoenix, AZ

20h • Onsite

About The Position

The UR Coordinator’s primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for all provided services. The UR Coordinator will function as liaison between payor source(s), the finance office, and the clinical treatment team, providing information and feedback to assist in optimum patient care and reimbursement.

Requirements

• Demonstrate positive and professional written, verbal and nonverbal communication skills.
• Navigate and effectively utilize relevant software such as Office 365, SmartSheets, Kipu, and Collaborate MD.
• Maintain effective interpersonal relationships with the clinical, medical, and administrative teams.
• Understand and apply state, federal, and local regulations and laws governing quality assurance and utilization review.
• Work independently.
• Analyze treatment plans and evaluate elements of assessment which include the diagnosis of client behavioral and emotional problems.
• Confidently alert appropriate clinical staff to expedite care and facilitate timely and accurate documentation of patient status.
• Use good judgment in order to make critical decisions about the medical necessity of treatment.
• Provide ongoing updates and notifications in the Sigmund Electronic Management system.
• High school diploma or equivalent.
• Knowledge of Psychological and social aspects and characteristics of mental illness and chemical dependency.
• Knowledge of Principles and methods of counseling and the accepted techniques for assessing psycho-social behavior.
• Knowledge of Human behavior and development.
• Knowledge of Problems, needs and attitudes of chemically dependent and dually diagnosed.
• Knowledge of Pertinent laws and regulations regarding health and social service programs.
• Knowledge of Federal, state and county regulations pertaining to utilization review.
• Knowledge of Methods and procedures of admissions, discharges and patient care in outpatient and inpatient behavioral health facilities.
• Knowledge of Medically Necessary Criteria of major third-party funding sources.
• Analytical Thinking - Uses logical reasoning to process, break down, and work through a situation or problem to arrive at an outcome.
• Communication - Clearly conveys and receives information and ideas through a variety of media to individuals or groups in a manner that engages the listener, helps them understand and retain the message, and invites response and feedback. Keeps others informed as appropriate. Demonstrates good written, oral, and listening skills.
• Collaboration - Builds constructive working relationships with clients/customers, other work units.
• Follow-up and case management of assigned patients and payers, to include authorizations, denial and the appeal process and follow up.
• Shows understanding in Medicaid plans medical necessity guidelines and Axioms forms needed to convey criteria.
• Ability to manage assigned MCO, precertification, concurrent review, Discharge clinical, Prior authorizations for stepdown.

Nice To Haves

• Utilization Review: 1-2 years preferred.

Responsibilities

• Review of patient admission data and clinical documentation to ensure compliance with insurance and governmental regulations relating to medical necessity and case documentation.
• Collect and compile data needed for prior authorization, concurrent review, discharge notifications and retrospective reviews.
• Ensure all authorization requests have been completed for inpatient and outpatient services, according to applicable facility and insurance policies.
• Maintains detailed and complete documentation regarding the UR process for each case.
• Actively communicate with interdisciplinary team regarding patient diagnosis, utilization of services, length of treatment, authorization status and case documentation.
• Participation with departmental staff in quality improvement meetings and projects.
• Preparing memorandum, letters, correspondence, and comprehensive UR status summaries.
• Other duties as assigned.

Benefits

• Medical, Dental, and Vision
• 401(k) with up to 3.5% match
• Paid time off (PTO), paid sick time, and paid holidays
• Tuition Reimbursement
• Reimbursement for CMEs
• Free criminal record clearance for eligible justice-impacted staff through a partnership with Rasa Legal
• Employee Assistance Program (EAP)
• Voluntary benefits including group term life, voluntary term life, AD&D, short term disability, and accident coverage

What This Job Offers

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