Job Description

Salary Range:  $45.4100 - $69.8500 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.

Part Time 1st Shift

Primary Duties and Responsibilities

The Utilization Review Coordinator (URC)  is responsible for the utilization review case management of all patients in The HATC Department within the assigned caseloads. This role provides utilization review with insurance payers and informs the interdisciplinary team of the payer status such as but not limited to authorizations and denials. The URC uses payer source information to report HATC treatment pathways, discharge plan, resources, and placement options that were provided to the patient by the clinical and or medical team that is reported in the clinical or medical notes and chart. The URC does not provide medical or clinical care to the patient. Knowledge of the HATC program is essential as the details are relayed to the insurance payers. The URC monitors progress towards established discharge goals and relays information to the insurance payers as requested during case reviews. Case reviews can occur by live call reviews, fax, or direct reviews in EPIC. Authorization numbers are recorded and entered in the application system that correlates to the level of care. HATC in-patient and out-patient authorization numbers are recorded in EPIC and Residential Treatment Center authorizations are recorded into KIPU. Update patient lists with “last covered date” with each review and add additional appointments in the EPIC out-patient schedule, if applicable. Other clerical duties are required such as scanning and uploading authorizations or document reviews. Other duties as assigned.

Education and Experience

• High School Diploma or equivalent
• One year of previous behavioral Health experience required
• Knowledge of ASAM Placement Criteria required
• Five years of clinical experience, preferably within a behavioral healthcare environment preferred
• One-year experience in Utilization Review, in an acute healthcare system environment preferred
• Knowledge of Interqual guidelines preferred.
• Licensed Vocational Nurse Preferred.
• Certified Alcohol and Drug Addiction Counselor (CADAC) preferred.
• RN preferred. 

License Preferred

• RN, LVN, CADAC

Certifications Required

• BLS

Certifications Preferred

• Certification in specialty field preferred.

Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.

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