Resource Recovery Center of Orange County

GENERAL DESCRIPTION: The Utilization Review (UR) Coordinator is responsible for contacting external case managers/managed care organizations for pre-authorization and concurrent reviews throughout the duration of a client’s SUD treatment stay.. Notifies appropriate clinical staff of need for pre-certification and clinical reviews.. Complete utilization assessments, pre-certification, discharge and peer reviews of inpatient SUD treatment services.. Is knowledgeable regarding The Joint Commission and OASAS regulations. State licensure required (CASAC, LCSW, LMHC, LMSW or other healthcare licensure).

utilization review coordinator

Salary Range: $58,500 - $70,000 Schedule: Monday - Friday 8am - 4:30 pm GENERAL DESCRIPTION: The Utilization Review (UR) Coordinator is responsible for contacting external case managers/managed care organizations for pre-authorization and concurrent reviews throughout the duration of a client’s SUD treatment stay. The Utilization Review Coordinator is responsible for utilization management for both incoming clients as well as current clients. The coordinator also assists the multi-disciplinary treatment team in understanding the different requirements that various insurance companies have for admission, continued stay, and discharge planning. TASK AND RESPONSIBILITIES: Reviews intake/admission data to determine medical necessity and appropriateness of admission based upon approved criteria and standards. Collects and records all information necessary for admission, extended stay and discharge clinical review. Notifies appropriate clinical staff of need for pre-certification and clinical reviews. Complete utilization assessments, pre-certification, discharge and peer reviews of inpatient SUD treatment services. Communicates with insurance and managed care companies to inform them of diagnoses and client physical/behavioral health status of patients. Conducts continuing-stay reviews to ensure patients in treatment require and are benefiting from the services they are receiving. Monitor clinical documentation to insure appropriate, timely and effective provision of services and treatment planning. Works closely with Compliance Manager to help ensure compliance and quality control. Interfaces with finance/billing and multi-disciplinary treatment team in matters of review decisions, discharge planning and fiscal communication. Ensure that all insurance information needed for billing and collection processes are obtained and recorded appropriately in the EMR system. Develops UR statistics and reports for review by supervisor and multi-disciplinary treatment team. Maintains confidentiality of all materials handled in performance of assigned duties. Knowledgeable of program operations and staff members. Actively participates as a supportive team member. Attends weekly/monthly staff meetings as appropriate. Is familiar with MS Word, Excel, Outlook and Access. Is knowledgeable regarding The Joint Commission and OASAS regulations Represents our agency with an ethical, fair and positive attitude. Other duties as assigned by the supervisor. MINIMUM QUALIFICATIONS: High School Diploma or equivalent; higher education in a behavioral health related field required Minimum of three years’ experience working in a mental health or chemical dependency setting, with a minimum of three years of utilization review experience required State licensure required (CASAC, LCSW, LMHC, LMSW or other healthcare licensure). Ability to utilize NYS LOCADTR 3.0 and ASAM Criteria to identify and advocate for appropriate level of care placement required Familiarity with all SUD Treatment Levels of Care and Treatment Modalities required SKILLS: Great interpersonal skills Attention to detail Excellent communication skills Computer skills which include Microsoft Office and Adobe Acrobat Experience working with EMR system Ability to work calmly under pressure Time-management and multitasking skills

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