Utilization Management Coordinator

Utilization Management Coordinator

Foundations Recovery Network (FRN) is the premier provider of integrated treatment for co-occurring addiction and mental health concerns, offering residential and outpatient services nationwide. Located in the serene forest foothills of northern Georgia, Black Bear Lodge is a 144‑bed place of solace and healing for those individuals suffering from addiction and mental health issues. We provide a comprehensive, integrated program that addresses the needs of the whole person—mind, body, and spirit.

Our system of care is personalized, evidence‑based, and research‑proven, allowing patients to self‑reflect and find strength for life change amid the beauty of the expansive sky and natural tranquility of our location.

• Reviews and understands insurance information provided by the Call Center, determines which benefits are available to client, and clarifies discrepancies or confusion.
• Determines what level of care the client meets and what ASAM (American Society of Addiction Medicine) criteria support that level of care based on client’s benefits.
• Once a care manager is established, contacts health plan provider and requests most appropriate level of care for client.
• Documents in system (NG, UR spreadsheet and Distribution spreadsheet) and in a paper file the request made and authorization approval number/contact information.
• Enters the appropriate level of care in Tier. This is based on the approved insurance level and is updated throughout treatment as the insurance changes.
• Notifies Business Office within 24 hours of level of care step down or denial.
• Sends daily email with review outcomes to treatment staff indicating level of care, days approved and notification of level change.
• Coordinates and assists with scheduling peer reviews.
• Coordinates patient’s clinical and after‑care needs with treatment team.
• Completes appeal and medical records as instructed.

• Caring, challenging, and rewarding work environment
• Competitive compensation
• Generous paid time off
• Excellent medical, dental, vision and prescription drug plans
• Career development opportunities within UHS and its 300+ subsidiaries

• Team collaboration
• Watching patient growth
• Beautiful campus—great mountain location
• Highly talented clinical team
• Diverse clientele

• High school degree or GED required; bachelor’s degree preferred
• Nursing degree or bachelor’s degree in psychology, social work, or related field preferred or commensurate experience acceptable
• Minimum of 1 year of experience in utilization review/case management preferred
• Minimum of 1 year of facility‑based psychiatric/substance abuse experience preferred

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal‑opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.