Utilization Review Coordinator

Recovery Centers of America (RCA) is a ground-breaking addiction and mental health treatment provider, setting the standard when it comes to accessible, affordable, and effective care. RCA understands the heartache, damage, and pain substance use disorder causes a person as well as their family and friends.

Not only do we believe that addiction treatment should be affordable, accessible, and evidence-based, but our driven, compassionate, and dedicated employees make those beliefs a reality! This is where you come in.

As a Utilization Review (UR) Coordinator at RCA, you will act to effectively compile and communicate to insurance an accurate description of the patient’s current presentation based on clinical findings to maximize insurance coverage. Working closely with medical, clinical, and primary therapists you will provide reliable trending analysis of current and past patient data to advocate for the extension of days authorized based on ASAM criteria.

Responsibilities:

Works on Utilization Review (UR) team and assists other members and managers.

Manage a daily UR caseload of patient’s based on facility census.

Consistently works with clinical, admissions, nursing, and medical teams to advocate for detailed documentation to maximize insurance covered days.

Effectively compile and communicate to insurance companies an accurate description of the patient’s current presentation based on clinical findings.

Provide reliable trending analysis of current and past data related to length of stay and days authorized by specific insurance companies.

Experience working with in-network/out-of-network benefits to maximize patient days.

Knowledge of all continuums of care, including admission assessment and continued stay criteria.

Education & Experience:

Associate's degree, bachelor's preferred1+ years' experience in Utilization Review (UR) (preferred)Specific experience in substance abuse or related field (preferred)Hours are Monday - Friday 8am - 4:30pm#appcast