Utilization Management Coordinator – Pre-Arrival

This is a fully remote position, open to applicants in Oklahoma.

📋 Description

• Deliver administrative and clinical assistance during patient evaluations, placement in care levels, receipt of required services, and discharge planning.

• Engage in treatment teams and relay reimbursement concerns to providers.

• Participate in the Patient Care Committee and the Utilization Review Staff Committee.

• Provide data and contribute to internal process enhancements.

• Offer educational support to staff as necessary.

• Adhere to review timelines and provide clinical information for authorization purposes.

• Address requests for additional clinical details.

• Supply eligibility, benefits, and level-of-care information to treatment teams and committees.

• Gather treatment information for service authorization evaluations.

• Aid in discharge planning and enhance quality-of-care processes.

• Identify and report triggers for quality improvement.

• Assess patient eligibility and benefits while aligning level-of-care utilization.

• Ensure adherence to managed care behavioral health standards and documentation requirements.

• Investigate and prepare insurance appeals concerning medical necessity or treatment issues.

• Contribute to ongoing utilization management and the enhancement of the utilization review process.

⛳️ Requirements

• Preferred experience in behavioral health, inpatient psychiatric care, or utilization management.

• Completion of the foundational professional curriculum from a nursing school accredited and verified by a state nursing board, holding a diploma or degree, or a Master’s degree in Social Work, Counseling, or a related behavioral health field.

• A valid multistate or State of Oklahoma Registered Nurse License, or LCSW, LPC, or LMFT license.

• 3–4 years of relevant experience in behavioral health care, with some time spent in behavioral health managed care.

• Proficient in Microsoft Word, Excel, and Access.

• Strong interpersonal, written, and verbal communication skills.

• Capability to analyze data to uncover facts or develop knowledge, concepts, or interpretations.

• Competence in organizing and prioritizing tasks effectively and efficiently.

• Attention to detail when reviewing numerical data.

• Ability to distill clinical case data into clear summaries.

• Availability for a Monday–Friday schedule from 8:00 a.m. to 4:30 p.m.

🏝️ Benefits

• Limited benefit offerings.

• Virtual Office arrangement.