Utilization Management Coordinator

Responsibilities

• Works with all payers to secure authorization for inpatient stays for all individuals admitted to Inpatient or COE Unit.
• Performs utilization review in accordance with all Payor requirements, State Regulations, and Joint Commission Standards. Ensures all payer utilization management staff receive needed daily information to perform their reviews.
• Obtain authorizations for previously identified procedures where required.
• Documents review information as required by State and Payor regulations. Communicates results to applicable payor sources: including requests to BHMP's for expedited follow-up to all payer UM staff.
• Complies with regulation changes affecting utilization management. Facilitates educational programs and advises physicians and other departments of regulations affecting utilization management.
• Performs all other duties as assigned.
• This is a fully remote position in these states: AL, AR, AZ, CA, CO, CT, DC, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MT, NC, NJ, OH, OR, PA, RI, SC, TN, TX, UT, VA, WA

Requirements

• High School Diploma or equivalent
• At least 2 years of behavioral health experience
• Expertise in Utilization Management responsibilities, tasks and functions, and/or Clinical auditing experience
• The Company has a mandatory vaccination policy. All successful applicants must be fully vaccinated, including showing proper documentation, or otherwise be exempt pursuant to the Company's exemption process prior to their start date as a condition of employment
• It would be great if you had:
• Bachelor's degree in Nursing, behavioral health, social work, medical coding, or related field
• Previous clinician (Social Work) experience
• Licensed MSW
• Strong organizational, documentation, and data-entry skills
• Excellent communication, customer service abilities
• Familiarity with Medicare, Medicaid, and commercial insurance requirements
• Proficient in Microsoft Excel for tracking, reporting, and record management
• Knowledge of ADHS/DBHS and RBHA Policies and Procedures relative to Utilization Management
• Previous experience obtaining authorization from third parties

Benefits

Additional Information

We're not just behavioral health people-we're crisis people. Connections Health Solutions is a leading provider of immediate-access behavioral health crisis care. Our team combines medical and recovery-oriented treatment to stabilize individuals in crisis and connect them to community-based resources for ongoing recovery. Founded by emergency room psychiatrists Dr. Chris Carson and Dr. Robert Williamson, our model is physician-led and data-driven, drawing upon more than 15 years of crisis care expertise. Recognized by SAMHSA and the National Council for Mental Wellbeing as a national best practice, we've delivered invaluable treatment to hundreds of thousands of individuals facing crises. Our commitment remains consistent, to improve access, inspire hope, and provide the right support. Our values shape our decisions, define our culture, and foster continuous learning and growth. We accept people as they are, creating safe spaces where they feel valued and respected. We inspire hope by walking with people side-by-side, showing them grace and compassion. We act with intention, holding ourselves and each other accountable, and doing the right thing. We work as one team, trusting and supporting each other. We embrace change and innovation, striving to find better ways to fulfill our mission. We are on a mission to change the face of behavioral health. Help us save lives and make a difference.

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