Utilization Review (UR) Coordinator

Apalachee Center-posted about 1 year ago
$41,600 - $45,760/Yr
Full-time • Entry Level
Onsite • Tallahassee, FL
Social Assistance
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The Utilization Review (UR) Coordinator is responsible for coordinating and conducting Utilization Management functions for the Apalachee Center, Inc. This role involves ensuring compliance with established policies and insurance requirements while providing support to clinical staff and managing authorization processes. The position is office-based in Leon County and is not eligible for remote work.

  • Conduct Utilization Management activities in accordance with Agency policies and insurance requirements.
  • Manage inpatient admission certifications and continued stay reviews for applicable insurances.
  • Submit discharge clinicals to applicable insurances within 48 hours of discharge.
  • Document authorization information in the electronic health record (EHR) daily.
  • Identify denials warranting appeal and work with the Billing & Insurance Department to submit formal appeals.
  • Notify relevant directors and officers of all inpatient denials.
  • Coordinate with the Central Receiving Facility and Billing & Insurance Department for prior authorizations.
  • Review compliance with Inpatient Medicare certification and assist in Recovery Audit Contract activities.
  • Participate in treatment team meetings to coordinate UR activities with the treatment team.
  • Provide consultation and education to clinical staff regarding documentation issues.
  • Complete monthly, quarterly, and year-to-date UR reports and distribute profiles.
  • Serve as Chair for the Utilization Management Sub-Committee, managing scheduling and meeting documentation.
  • Bachelor's Degree in Psychology, Social Work, Counseling, or a related field.
  • One year of related professional administrative experience in utilization management or quality assurance preferred.
  • Professional clinical experience in a psychiatric or community mental health setting preferred.
  • Familiarity with Joint Commission, Children & Families licensure regulations, Medicaid, Medicare, and managed care standards preferred.
  • Familiarity with Healthcare Effectiveness and Data Information Set (HEDIS) measures preferred.
  • Valid Drivers License preferred.
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Basic life insurance
  • Long term disability
  • Paid time off
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