Utilization Review Coordinator

The Utilization Review (UR) Coordinator is responsible for coordinating the clinical review process to ensure appropriate utilization of inpatient psychiatric services while maximizing reimbursement through timely authorization, concurrent review, and denial prevention. Working collaboratively with providers, nursing, and social work, the UR Coordinator ensures patients meet medical necessity criteria throughout their hospitalization, and documentation supports payer requirements. 

This position serves as a key liaison between the hospital and insurance payers to promote quality patient care, regulatory compliance, and financial stewardship.

Education 

• Registered Nurse or other qualified behavioral health clinician strongly preferred. 

• Bachelor's degree required. 

Experience 

• 3+ years of inpatient behavioral health experience. 

• Previous utilization review, case management, discharge planning, or managed care experience are strongly preferred. 

• Experience with commercial insurance, Medicare, Medicaid, and managed care authorization processes. 

Knowledge, Skills, and Abilities 

• Strong understanding of behavioral health medical necessity criteria (MCG preferred). 

• Knowledge of psychiatric documentation standards and payer expectations. 

• Experience conducting concurrent reviews and communicating effectively with insurance reviewers. 

• Excellent clinical assessment and critical thinking skills. 

• Strong verbal and written communication abilities. 

• Exceptional organizational and time management skills. 

• Ability to manage multiple payer deadlines simultaneously. 

• Proficiency with electronic medical records. 

• Strong collaboration and team building skills with interdisciplinary teams.