Job Details

Utilization Review Coordinator

The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance companies and payer services to obtain authorization for treatment services provided by Sunshine Behavioral Health. The Utilization Review Coordinator must be familiar with admissions pre-certification process as well as concurrent and discharge reviews. Extensive knowledge of medical terminology, substance abuse and mental health disorders, ASAM criteria and ICD-10 diagnosis codes is necessary.

Major Duties And Responsibilities:

• Complete assessments and pre-certifications for clients.
• Communicate necessary information received to appropriate staff in a timely and efficient manner.
• Demonstrate understanding of medical terminology.
• Demonstrate understanding of policy deductibles, co-pays, co-insurance and out of pocket maximums, out of network deductions and exclusions.
• Demonstrate knowledge of EOB interpretation.
• Daily use of ten key, data entry and spreadsheets applications.
• Communicate effectively with peers and supervisor to address billing and claim issues.
• Follow all HIPAA, compliance, privacy and confidentiality standards.
• Participate in development of Quality Improvement projects.
• Follow all practices detailed in the company's Policies and Procedures Manual and Employee Handbook.
• Attend and participate in staff meetings and trainings.
• Demonstrate expertise in Psychiatric and Addiction Disorders.
• Engage in appropriate written and verbal communication with families, insurance companies and other professionals.
• Demonstrate ability to work with Excel, Word and electronic chanting.
• Ability to work with minimal supervision.
• Organized and detail oriented.
• Other duties as assigned.

Essential Knowledge, Skills, And Abilities:

Knowledge: The UR Coordinator will:

• Possess proficiency in Excel, Word and electronic charting.
• Demonstrate ability to multi-task.
• Demonstrate ability to work with minimal supervision.
• Basic knowledge of HIPAA.
• Possess excellent customer service skills.
• Demonstrate ability to work under pressure.

Abilities: To excel in this position the incumbent should be able to demonstrate the following competencies:

• Problem Solving – The UR Coordinator will be able to identify and resolve problems in efficient and effective ways.
• Ethics – Treat clients, staff, co-workers, visitors, contractors, and guests of Sunshine Behavioral Health with respect and dignity; work ethically and uphold the values and standards of Sunshine Behavioral Health.
• Attendance, Punctuality, Reliability – Arrive on-site, on-time, as scheduled, consistently with a professional disposition. Ensure all work responsibilities are covered in the event of an absence or scheduled vacation.
• Leadership – Constant development of staff, co-workers and clients, in effort to achieve each individual's highest potential.
• Strong Character – Staying calm under pressure is essential. Having an approachable demeanor without compromising Sunshine Behavioral Health Standards of ethics and workmanship.
• Flexibility – Openness to different and new ways of doing things; willingness to modify one's preferred way of doing things.
• Organization – Must be highly organized and efficient in managing the necessary daily client/staff demands and tasks associated with them.

Qualifications And Preferences:

• A minimum of two years of experience with Utilization Review.
• HS Diploma, college degree preferred.
• Excellent customer service skills.
• Valid Driver's License.

Sunshine Behavioral Health is an equal opportunity employer and prohibits discrimination and harassment of any kind.

Tuesday - Saturday