UM Coordinator (Utilization Management)

Description

Purpose

The Utilization Management (UM) Coordinator plays a critical role in ensuring the delivery of high-quality, cost-effective care by overseeing treatment team, utilization review processes, coordinating discharge planning, and serving as a residential care navigator. This position supports clinical teams in maintaining compliance with payer requirements, facilitates timely transitions of care, and advocates for client needs across the continuum of services.

Essential Job Functions:

• Coordinates multidisciplinary treatment team meetings, including scheduling, notifications, invitations, and expectations for required documentation to ensure coordination of care. Document all verbal discussions of youth progress during treatment team meeting.
• Works with the multidisciplinary treatment team, including representatives from the payer source, to effectively locate recommended services as a part of discharge planning.
• Submits concurrent authorization to insurance providers accurately and in a timely manner and follow up on approvals or denials, as needed.
• Maintains accurate records of authorization status and communicate updates to relevant departments, as well as document updates in the EHR.
• Serves as a liaison between residential staff, clinical teams and external stakeholders.
• Maintains an appropriate and professional relationships with social workers, school staff, therapists, parents/legal guardians and other community and team members as needed.
• Conducts follow up interviews with youth and their families at designated intervals post-discharge.
• Serves as a member of the Admissions Department, assisting with tasks as needed, such as reviewing referrals, pre-placement assessments, and facilitating admission appointments.
• Assists in audits and reporting data to other departments related to utilization. 
• Maintains compliance with state, federal and accreditation standards.
• Attends all required trainings and in-services as assigned.
• Performs any other duties as assigned.  

Starting Pay: $25/hr

Requirements

On-Site Position

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Education and/or Experience

• Bachelor’s degree in a related field with 1+ years of experience in behavioral health, utilization management, or discharge planning. Preferably a background in case management. 
• Strong understanding of payer requirements, medical necessity criteria, and behavioral health systems of care.
• Excellent communication, organizational, and problem-solving skills.
• Proficiency in electronic health records (EHR), preferably myEvolv.