UM Coordinator

At New Vista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.

The Utilization Management (UM) Coordinator supports the facility’s utilization review and authorization processes for patients receiving mental health and behavioral health services. This position coordinates with clinical staff, insurance companies, managed care organizations, patients, and external providers to ensure services are appropriately authorized, documented, and reviewed in accordance with payer requirements and facility policies.

The UM Coordinator maintains accurate and timely records, tracks authorization requirements and review deadlines, assists with concurrent and retrospective reviews, and communicates changes in authorization status to the appropriate members of the treatment team.

• Coordinate initial, concurrent, continued-stay, and discharge-related utilization review activities.
• Obtain and track insurance authorizations for behavioral health services, including inpatient, residential, partial hospitalization, and/or intensive outpatient services as applicable.
• Verify patient insurance benefits, eligibility, and behavioral health coverage requirements.
• Submit clinical information and supporting documentation to insurance companies and managed care organizations as required.
• Maintain accurate authorization records, including approved levels of care, number of authorized days/units, review dates, and authorization numbers.
• Monitor authorization expiration dates and proactively notify clinical staff of upcoming reviews or additional information needed.
• Coordinate peer-to-peer reviews and communicate payer requests to appropriate clinical personnel.
• Assist with appeals, denials, and requests for additional clinical information.
• Communicate authorization decisions and changes in coverage to the treatment team, admissions staff, billing staff, and other appropriate departments.
• Ensure utilization management documentation is complete, accurate, timely, and maintained in accordance with facility and regulatory requirements.
• Review clinical documentation for completeness and identify missing information needed to support medical necessity reviews.
• Maintain confidentiality of protected health information in accordance with HIPAA and applicable federal and state regulations.
• Assist with identifying utilization trends, authorization issues, denials, and opportunities for improved coordination of care.
• Participate in quality improvement and utilization management activities as assigned.
• Maintain professional communication with payers, patients, families, providers, and internal departments.
• Perform other duties related to utilization management and clinical operations as assigned.

• High school diploma or equivalent.
• Must be 21 or older
• Experience in healthcare, behavioral health, medical records, insurance verification, utilization management, or a related administrative/clinical support role.
• Knowledge of insurance authorization and/or managed care processes preferred.
• Strong organizational and time-management skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple deadlines and priorities in a fast-paced healthcare environment.
• Proficiency with electronic medical records and Microsoft Office or comparable software.
• Ability to maintain confidentiality and handle sensitive patient information appropriately.

• Multiple medical plan options, Vista Wellness (physician/pharmacy), Dental, Vision
• Generous PTO and paid holidays
• 401(k) with company contribution;
  Life and disability coverage
• Tuition reimbursement up to $15,000 and student loan forgiveness programs