Utilization Review Coordinator

Axiom Care is a fast-paced, rapidly growing substance abuse treatment and sober living housing provider with locations in the Phoenix metro area and Apache Junction. We primarily serve low-income and justice-involved individuals who are seeking to change their life for the better. We achieve this by offering multiple levels of care along with medical services, evidence-based professional counseling, case management, housing assistance, employment assistance, and more. 

Job Summary 

The UR Coordinator’s primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for all provided services. The UR Coordinator will function as liaison between payor source(s), the finance office, and the clinical treatment team, providing information and feedback to assist in optimum patient care and reimbursement.  

Duties/Responsibilities 

• Review of patient admission data and clinical documentation to ensure compliance with insurance and governmental regulations relating to medical necessity and case documentation. 
• Collect and compile data needed for prior authorization, concurrent review, discharge notifications and retrospective reviews.  
• Ensure all authorization requests have been completed for inpatient and outpatient services, according to applicable facility and insurance policies.    
• Maintains detailed and complete documentation regarding the UR process for each case. 
• Actively communicate with interdisciplinary team regarding patient diagnosis, utilization of services, length of treatment, authorization status and case documentation. 
• Participation with departmental staff in quality improvement meetings and projects. 
• Preparing memorandum, letters, correspondence, and comprehensive UR status summaries. 
• Other duties as assigned. 

Supervisory Responsibilities 

• None. 

Required Skills/Abilities:  

• Demonstrate positive and professional written, verbal and nonverbal communication skills.  
• Navigate and effectively utilize relevant software such as Office 365, SmartSheets, Kipu, and Collaborate MD. 
• Maintain effective interpersonal relationships with the clinical, medical, and administrative teams. 
• Understand and apply state, federal, and local regulations and laws governing quality assurance and utilization review. 
• Work independently. 
• Analyze treatment plans and evaluate elements of assessment which include the diagnosis of client behavioral and emotional problems. 
• Confidently alert appropriate clinical staff to expedite care and facilitate timely and accurate documentation of patient status.  
• Use good judgment in order to make critical decisions about the medical necessity of treatment. Provide ongoing updates and notifications in the Sigmund Electronic Management system. 

Education and Experience 

• High school diploma or equivalent. 
• Utilization Review: 1-2 years preferred. 
• Knowledge of: 
• Psychological and social aspects and characteristics of mental illness and chemical dependency. 
• Principles and methods of counseling and the accepted techniques for assessing psycho-social behavior. 
• Human behavior and development. 
• Problems, needs and attitudes of chemically dependent and dually diagnosed. 
• Pertinent laws and regulations regarding health and social service programs. 
• Federal, state and county regulations pertaining to utilization review. 
• Methods and procedures of admissions, discharges and patient care in outpatient and inpatient behavioral health facilities. 
• Medically Necessary Criteria of major third-party funding sources. 

Required Competencies:  

• Analytical Thinking - Uses logical reasoning to process, break down, and work through a situation or problem to arrive at an outcome.  
• Communication - Clearly conveys and receives information and ideas through a variety of media to individuals or groups in a manner that engages the listener, helps them understand and retain the message, and invites response and feedback. Keeps others informed as appropriate. Demonstrates good written, oral, and listening skills. 
• Collaboration - Builds constructive working relationships with clients/customers, other work units. 
• Follow-up and case management of assigned patients and payers, to include authorizations, denial and the appeal process and follow up. 
• Shows understanding in Medicaid plans medical necessity guidelines and Axioms forms needed to convey criteria. 
• Ability to manage assigned MCO, precertification, concurrent review, Discharge clinical, Prior authorizations for stepdown. 

Physical Requirements: 

• Prolonged periods of sitting at a desk and working on a computer. 
• Must be able to lift up to 15 pounds at times.