Utilization Review Coordinator

UR Coordinator Sierra Health and Wellness use evidence-based methods to accomplish the restoration of families, relationships, and self-worth. By transforming the character, we give life back to the people who have lost it through substance abuse and mental health issues. Position Open: Full-time- remote- Texas Benefits: 10 days paid vacation 10 holidays/ 5 sick days per year Medical, Dental, and Vision benefits with NO monthly premium for the employee (eligible after 60 days of employment) 401K with a company match of up to 3% (eligible after 1 year and 1,000 hours of employment) Employer-paid Accident & Life Insurance (eligible after 60 days of employment) Job Description: The role of the Utilization Review Coordinator is to implement the organization’s Utilization Review (UR) process to ensure appropriate usage of available resources and to optimize reimbursement for services rendered in accordance with patient need. Ensure UR function is performed in compliance with the P&P, certification standards, and State/Federal statutes and/or regulations. Essential Functions : Reasonable accommodation may be made to enable individuals with disabilities to perform these essential functions. Monitors the client population daily and regularly checks documentation for compliance with current UR best practices. Gather information and contact insurance case managers with accurate reports on clients’ medical information and the level of engagement in treatment. Maintain an accurate account of the level of care granted by the insurance companies. Maintain daily information on the client that is accurate and held to strict confidentiality and HIPAA regulations. Participate in staffing meetings. Conduct peer reviews as well as pre-certifications and concurrent reviews. Conduct staff training. Audit EHR documentation as well as document all client-related activities in the EHR. Performs other duties and tasks as assigned. Required education and experience : High School Diploma or GED. One year of experience working with adults struggling with substance abuse. Valid Driver’s License Preferred education and experience : Three years of experience working as a Utilization Review Coordinator or similar role. Sierra Health and Wellness is a California network of leading behavioral health and rehab centers for adults and families who suffer from addiction to alcohol, opiates, amphetamines and other addictive substances. Sierra Health and Wellness is an Equal Opportunity Employer that does not discriminate against applicants, employees or clients on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, veteran status or any other category protected by the law, or patients' decisions regarding advance directives. Not all services are available at all offices.