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

• Conduct reviews for admissions, ongoing stays, and discharges for all managed care clients.

• Foster and maintain positive relationships with referral sources and insurance companies.

• Monitor admissions, ongoing stay, and discharge ASAM requirements for county referrals.

• Keep an organized reporting system to notify counselors about due ASAMs and upcoming review calls.

• Ensure current insurance eligibility information is maintained through EVS, Navinet, and other platforms.

• Oversee Census for accurate funding tracking.

• Participate in clinical staffing to gather information for client reviews.

• Accurately maintain the daily UR database.

• Conduct Act 106 reviews and handle follow-up appeals.

• Document all county referrals for admission call tracking.

• Engage in chart reviews to confirm that all necessary paperwork is in order.

• Collaborate directly with the Billing Department to minimize uncovered funding days.

• Investigate cases with insurance and referral sources to recover lost funding days.

• Provide weekly reports to the Assessment Manager.

• Manage all self-pay clients along with those with copays, deductibles, coinsurance, and other liabilities.

• Work to reduce client account balances.

• Perform additional duties as assigned.

• An Associate Degree or equivalent is required; a Bachelor of Science in Behavioral Health is preferred.

• Intermediate computer skills and internet proficiency are necessary.

• Experience with Microsoft Office applications (Intermediate level in Excel and Word).

• A minimum of 3-5 years’ experience in Utilization Review or a similar role within a healthcare environment.

• Medical, Dental, and Vision Insurance.

• Flexible Spending Accounts.

• Life Insurance.

• Paid Time Off.

• 401(k) with Company Match.

• Tuition Reimbursement.

• Employee Recognition Programs.

• Referral Bonus opportunities.

• And More!

Utilization Review Coordinator

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