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Utilization Review Coordinator

2 months ago

Phoenix, Arizona, United States Axiom Care Full time
Job Summary

Axiom Care is a rapidly growing healthcare organization providing substance abuse treatment and sober living housing services. We serve low-income and justice-involved individuals seeking to change their lives for the better. Our comprehensive approach includes medical services, evidence-based counseling, case management, housing assistance, and employment support.

Key Responsibilities
  • Manage and review patient resource utilization, ensuring compliance with insurance and governmental regulations.
  • Collect and compile data for prior authorization, concurrent review, discharge notifications, and retrospective reviews.
  • Ensure all authorization requests are completed for inpatient and outpatient services, adhering to facility and insurance policies.
  • Maintain detailed documentation regarding the utilization review process for each case.
  • Communicate effectively with the interdisciplinary team regarding patient diagnosis, service utilization, treatment length, authorization status, and case documentation.
  • Participate in quality improvement meetings and projects with departmental staff.
  • Prepare memoranda, letters, correspondence, and comprehensive utilization review status summaries.
Requirements
  • Demonstrate excellent written, verbal, and nonverbal communication skills.
  • Navigate and effectively utilize relevant software, including Office 365, SmartSheets, Kipu, and Collaborate MD.
  • Maintain effective interpersonal relationships with clinical, medical, and administrative teams.
  • Understand and apply state, federal, and local regulations and laws governing quality assurance and utilization review.
  • Work independently and analyze treatment plans to evaluate elements of assessment, including diagnosis of client behavioral and emotional problems.
  • Use good judgment to make critical decisions about medical necessity and provide ongoing updates and notifications in the Sigmund Electronic Management system.
  • Knowledge of psychological and social aspects of mental illness and chemical dependency, principles and methods of counseling, human behavior and development, and pertinent laws and regulations.