Position Purpose

The Utilization Review Coordinator plays a critical role in supporting Aspen BHC’s mission to deliver clinically effective, patient-centered care. Reporting directly to the Vice President of Revenue Cycle Management and co-managed by the Chief Executive Officer, this position is responsible for coordinating all utilization management functions across the facilities and/or cases assigned.

The Utilization Review Coordinator ensures that all pre-authorizations, concurrent reviews, and continued stay requests are completed accurately and within required timeframes for all payers, including commercial insurance, Medicaid, and managed care organizations. The position serves as the central liaison between the clinical team, medical staff, and payers to communicate patient progress, medical necessity, and authorization needs.

This role also ensures that clinical and medical staff receive appropriate training and guidance on documentation standards, authorization processes, and payer expectations. The Utilization Review Coordinator is responsible for timely and accurate reporting, maintaining detailed and compliant documentation, identifying trends that impact authorization outcomes, and supporting process improvements to enhance overall revenue cycle performance.

Education & Experience

Bachelor’s or master’s degree with a healthcare focus preferred.

Preferred 3+ years of experience working in Behavioral Health

Licensure/Certification

Preferred to have a clinical or nursing certificate or license.

Knowledge & Training

Comprehensive understanding of utilization management and medical necessity criteria, including ASAM and DSM-5 standards.

Knowledge of payer authorization and concurrent review processes for behavioral health services (inpatient, residential, PHP, IOP, detox).

Familiarity with Medicaid, Medicare, and commercial payer requirements and documentation standards.

Strong working knowledge of clinical documentation practices, including treatment planning, progress notes, and discharge summaries.

Proficiency in electronic medical record systems and payer portals for authorization management (e.g., Kipu, Availity, or equivalent).

Training in HIPAA compliance, confidentiality standards, and protected health information handling.

Demonstrated ability to interpret and apply medical, clinical, and behavioral health terminology accurately in written and verbal communication.

Knowledge of UR reporting methods, data tracking, and payer communication documentation.

Areas of Responsibility

1. Authorization Management

o Complete and submit all pre-authorization, concurrent, and continued stay reviews for all levels of care within required timelines.

o Communicate clinical information to payers to support medical necessity and ensure continued authorization.

o Track authorization start and end dates to prevent service gaps or denials.

o Coordinate with facility teams to ensure payer notifications and approvals are completed promptly.

2. Clinical Collaboration

o Work closely with clinical, nursing, and medical teams to ensure documentation supports payer requirements.

o Provide real-time feedback and education to staff on documentation or medical necessity issues.

o Participate in interdisciplinary team meetings to discuss patient progress and authorization updates.

3. Documentation and Reporting

o Maintain detailed and compliant records of all payer communications, reviews, and outcomes.

o Prepare and distribute utilization reports, denial summaries, and trend analyses for leadership review.

o Ensure all UR-related documentation is uploaded into the EMR accurately and promptly.

4. Compliance and Quality Assurance

o Ensure compliance with payer requirements, regulatory standards, and internal UR policies.

o Identify and escalate potential compliance or documentation issues to leadership.

o Assist in audits and provide records as requested by payers or regulatory agencies.

5. Training and Development

o Provide ongoing education and support to clinical and medical staff on UR processes and payer expectations.

o Participate in departmental and organizational training initiatives to remain current on payer trends, policies, and best practices.

6. Communication and Coordination

o Serve as the primary point of contact between Aspen BHC and external payers for all utilization-related inquiries.

o Communicate effectively with leadership, clinical teams, and billing departments to ensure alignment across processes.

o Support leadership in developing strategies to reduce denials and improve authorization turnaround time.

Salary Expectations

Annual salary expectations between $60,000 - $70,000 (salary will be based on qualifications and experience)

Job Type: Full-time

Base Pay: $60,000.00 - $70,000.00 per year

Benefits:

Dental insurance
Employee assistance program
Flexible schedule
Health insurance
Health savings account
Life insurance
Paid time off
Professional development assistance
Vision insurance

Work Location: In person

Aspen BHC

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Utilization Review Coordinator