Behavioral Health Review Coordinator

6 days ago


Nashville, Tennessee, United States Newport Healthcare Full time
About Us

Newport Healthcare is a leading provider of behavioral healthcare services, dedicated to delivering high-quality care to young people and their families. Our team of experts is committed to transforming lives through evidence-based treatment and support.

Job Summary

We are seeking a highly skilled Clinical Utilization Specialist to join our team. As a key member of our Utilization Review Department, you will be responsible for managing an active caseload of clients and ensuring seamless communication with insurance companies, clinical teams, and families.

Key Responsibilities
  • Case Management: Coordinate and schedule reviews to ensure continuous coverage and effective communication with insurance case managers, facility staff, and healthcare partners.
  • Review Coordination: Conduct and manage initial, concurrent, and discharge reviews to optimize benefits and utilization, while representing the UR Department in a professional and positive manner.
  • Client Communication: Maintain contact with clients' families and keep them updated on current insurance authorization updates, peer reviews, and denials.
  • Documentation: Document all activities in a detailed manner in applicable CRM/EMR systems.
  • Collaboration: Collaborate with clinicians and the multidisciplinary team daily to obtain necessary clinical documentation for reviews and ensure effective utilization of resources.
  • Meetings and Reporting: Participate in weekly treatment team and continuing care meetings as appropriate, and prepare and submit appeal documentation to the appropriate entities as indicated.
Qualifications
  • At least two (2) years of work experience in the behavioral health field.
  • Active license or credential in a behavioral health field preferred.
  • Bachelor's or Master's degree in a behavioral health-related specialty preferred.


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