Utilization Review Coordinator

Job Description:

Utilization Review Coordinator (Part-Time)

Remote Position (Must reside in CT, MA, NY, or NJ)

About the Position:

Mountainside is looking for a highly motivated Utilization Review (UR) Coordinator (Part Time) that will assist the Utilization Review team in supporting clients with the managed care processes for Intensive Outpatient (IOP) and Outpatient (OP) levels of care. This includes authorizations, discharge calls, participation in team meetings, and completion of pre-certifications as needed. This role also involves administrative and clerical support to ensure timely and accurate processing of insurance-related documentation.

Your Role:

• Demonstrate a foundational understanding of the Managed Care system, including:
• ASAM criteria
• Precertification, peer reviews, discharge reviews, and appeals
• Claims process and behavioral health benefit verification
• Manage IOP/OP authorizations and documentation in alignment with regulatory and payer requirements
• Assist with the completion of scheduled assessments and pre-certifications in coordination with third-party billing partners
• Conduct and document discharge-related calls and complete required audits
• Attend team meetings and provide utilization updates as appropriate
• Scan, upload, and track certification forms and claims-related documents daily
• Maintain accurate and organized electronic records for current and past client certifications
• Support the UR team with daily schedule creation and task delegation
• Serve as a liaison between clinical teams, administrative departments, and insurance providers to coordinate benefits and authorizations
• Deliver quality customer service to clients and families in a respectful and compassionate manner
• Maintain professional and collaborative relationships with colleagues, insurance contacts, and external partners
• Perform all additional tasks aligned with the scope and function of the UR department

What We Are Looking For:

• Embrace Mountainside's culture of Best in Class Service across all interactions
• Follow all policies, procedures, and compliance requirements
• Attend required trainings as directed by Human Resources or your supervisor
• Remain current in role-specific responsibilities and industry developments
• A driven, goal-oriented professional with a talent for persuasive communication
• Strong multitasking and organizational skills, with excellent attention to detail.
• Comfortable with EMR systems, and understanding of insurance
• Undertake additional duties as directed by your manager

Qualifications:

• High School Diploma required
• Bachelor’s Degree or active enrollment in degree program preferred
• Minimum 6 months of experience in substance abuse or behavioral healthcare setting 
• Familiarity with DSM-V, ICD-10, and clinical terminology
• Experience with EMR systems and Microsoft Office Suite (Excel, Word, PowerPoint)

Compensation:

The base rate of pay for this position is $22.00 to $24.00 per hour. Actual pay is determined based on a number of job-related factors including skills, education, training, credentials, experience, scope and complexity of role responsibilities, geographic location, performance, and working conditions.

About Mountainside:

Mountainside Treatment Center is a dynamic, fast-paced and growing recovery facility that values innovation and an obsession with providing Best in Class service to our Clients. Founded in 1998, we are a leading behavioral healthcare provider dedicated to treating alcohol dependency and drug addiction. Accredited by The Joint Commission and CARF for its high standards of care, Mountainside seeks out passionate and talented individuals to join its staff. We believe that every employee, regardless of position, plays a vital role in our success.

Here at Mountainside Treatment Center, we strongly prefer all employees to be fully vaccinated for Covid-19 (including regularly scheduled boosters) and the Flu as recommended by the CDC.

Mountainside is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.