Utilization Review Coordinator

Company: VirtualVocations
Location: Naperville
Posted on: November 2, 2024

Job Description:

A company is looking for a Utilization Review Coordinator to evaluate patient care and ensure compliance with medical necessity standards.



Key Responsibilities

Conduct in-depth reviews of patient records and treatment plans to assess medical necessity
Approve or deny service requests based on clinical criteria and communicate decisions to healthcare providers
Collaborate with interdisciplinary teams to coordinate care and advocate for high-quality, cost-effective treatment


Required Qualifications

Valid license as a Registered Nurse (RN), LCSW, LPC, or LMFT in good standing
Minimum of 3 years of clinical experience in behavioral health, with at least 1 year in utilization review or case management preferred
Proficiency in applying behavioral health clinical guidelines and utilization management criteria
Familiarity with federal, state, and local regulations related to behavioral health and utilization management
Experience using electronic health records (EHR) and utilization management software

Keywords: VirtualVocations, Waukesha , Utilization Review Coordinator, Other , Naperville, Wisconsin