Utilization Review CoordinatorYour Behavioral Health • Torrance, California, United States
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Utilization Review Coordinator
Your Behavioral Health
- Torrance, California, United States
- Torrance, California, United States
Über
Obtain initial and concurrent authorizations for Detox, Residential, PHP, and IOP programs Obtain TMS service authorizations for Neuro Wellness Spa Conduct clinical reviews and advocate with commercial health plans to support medically necessary care Track authorization timelines and follow up promptly on outstanding requests
Documentation & Systems:
Maintain accurate, real-time records of authorization activity Gather and review clinical documentation to support authorization requests Document all communications with payors clearly and thoroughly
Collaboration & Communication:
Communicate regularly with insurance representatives, clinical teams, and leadership about authorization status and updates Work collaboratively with the UR team to improve processes and enhance coordination of care
Denials & Appeals Support:
Assist with denial management, support appeal efforts with case summaries and clinical data Help identify trends in authorization delays or denials and provide input to leadership
Other Duties:
Perform other responsibilities as assigned to support team goals and company needs
Qualifications:
1–2 years of utilization review experience, preferably in behavioral health or mental health settings Experience obtaining Detox, Residential, PHP, and IOP authorizations with commercial payors Familiarity with TMS treatment and authorization processes Experience with commercial health plans and payor authorization protocols Proficiency with EMR systems, Microsoft Word, and Excel Strong written and verbal communication skills Ability to multitask, prioritize, and work efficiently in a fast-paced environment Professional, collaborative, and passionate about patient advocacy
Schedule: M-F(fully on-site).
Sprachkenntnisse
- English
Hinweis für Nutzer
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