Description
Position Overview:
Seeking a detail-oriented and motivated Utilization Review (UR) Coordinator to support the insurance authorization process across all levels of care at a Behavioral Health and Neuro Wellness Spa. The UR Coordinator plays a key role in securing timely authorizations, collaborating with clinical teams, and advocating for clients to access medically necessary care. This position requires strong communication skills, persistence, and experience with behavioral health
utilization review, including TMS services.
We would be willing to work with someone Part Time also if Full Time is not an option.
Requirements
Key Responsibilities:
Insurance Authorizations:
- Obtain initial and concurrent authorizations for all levels of care at including Detox, Residential, PHP, and IOP.
- Obtain authorizations for Transcranial Magnetic Stimulation (TMS) services provided at the Wellness Spa.
- Advocate on behalf of clients to secure medically necessary treatment with commercial health plans.
- Conduct clinical reviews with insurance representatives via phone and written communication.
- Track authorization timelines, proactively follow up on pending authorizations, and escalate delays when appropriate.
Documentation & Systems:
- Document all authorization activities and communications in EMR (Kipu) and related systems.
- Collaborate with clinical teams to gather and review documentation to support authorization requests.
- Maintain accurate, up-to-date records of authorization statuses, approvals, and denials.
Collaboration & Communication:
- Communicate regularly with insurance representatives, clinical teams, and leadership regarding authorization status.
- Partner with the UR team to ensure seamless coordination of care across programs and services.
- Participate in team meetings, offering feedback to support process improvement.
Denials & Appeals Support:
- Assist with denial management by supporting appeal efforts with documentation and case summaries.
- Identify trends in authorization delays or denials and provide feedback to leadership.
Other Responsibilities:
- Perform additional duties as assigned by the UR Manager, Director of Payor Relations, or leadership team to support organizational needs.
