Utilization Review Coordinator

Description

About the Position:

The Utilization Review position focuses on ensuring the appropriate level of care for clients by coordinating with insurance providers, reviewing clinical documentation, and collaborating with treatment teams to optimize client care.

Schedule:

Sunday - Thursday: 8:00 AM - 4:30 PM

Your Role:

• Conducts utilization reviews to ensure appropriate levels of care for clients.
• Collaborates with clinical teams to gather and review documentation for insurance authorization.
• Communicates with insurance providers to obtain approvals and extensions for treatment.
• Monitors length of stay and identifies potential barriers to continued coverage.
• Ensures compliance with ASAM criteria and other industry standards.
• Tracks and analyzes key performance indicators (KPIs) related to authorization success rates.
• Identifies trends in insurance denials and works with teams to improve documentation quality.
• Assists in coordinating appeals for denied claims, providing clinical justification.
• Works closely with the Crisis Intervention team, Recovery Coaching, Outpatient and Residential departments to ensure continuity of care.
• Maintains accurate records of authorizations, denials, and appeals in relevant systems.
• Supports program development by contributing insights from utilization review trends.
• Participates in team meetings to provide updates on insurance-related challenges and successes.
• Assists with training new staff on utilization review processes and documentation best practices.
• Utilizes tech-enabled solutions to streamline review and authorization workflows.
• Ensures timely follow-up on pending authorizations and communicates updates to relevant stakeholders.

Qualifications:

• Bachelor’s degree in related field
• Experience in working with insurance from a utilization review perspective 
• Experience in working with DSM-IV and knowledge documentation
• Preferred Licensure/Certificate: Certified in Addiction Counseling
• Excellent communication, organization, and time management skills

Compensation:

The base rate of pay for this position is $24.00 to $26.00 per hour. Actual pay is determined based on a number of job-related factors including skills, education, training, credentials, experience, scope and complexity of role responsibilities, geographic location, performance, and working conditions.

Benefits:

• Comprehensive benefit package
• Paid Time Off (which increases after 1 year with Mountainside)
• Paid holidays including a Multicultural Holiday
• 401(k) with employer matching
• Free meals while working on the Canaan campus
• Monthly $75.00 wellness reimbursement. Our Wellness Reimbursement benefit is meant to encourage employees to engage in productive self-care to avoid burnout and compassion fatigue.

About Mountainside:

Mountainside Treatment Center is a dynamic, fast-paced and growing recovery facility that values innovation and an obsession with providing Best in Class service to our Clients. Founded in 1998, we are a leading behavioral healthcare provider dedicated to treating alcohol dependency and drug addiction. Accredited by The Joint Commission and CARF for its high standards of care, Mountainside seeks out passionate and talented individuals to join its staff. We believe that every employee, regardless of position, plays a vital role in our success.