Utilization Review Coordinator

General Summary of Duties: The Utilization Review Coordinator conducts utilization reviews to determine medical necessity and resource consumption during an outpatient course of treatment.

The Utilization Review Specialist assists in the operations of Kitsap Mental Health Services (KMHS) in support of its stated mission and provides the highest level of customer service to internal and external customers.

Supervisory Responsibilities : None

Major Responsibilities/Tasks :
  • Analyze and Review clinician requests for reauthorization of level of care to determine whether the client is meeting: Medical necessity and Level of Care Standards.
  • Consult with appropriate leadership for denials.
  • Manage the reporting processes and data gathering in order to maintain statistical information.
  • Initiate and send to the Utilization Management team any recommendations for further review.
  • Acts as liaison for all payer audits, specifically the Managed Health Care Organizations.
  • Coordinates between internal departments to gather required information for the audit request.
  • Manages all Managed Health Care outcomes (i.e., corrective action, additional documentation needed, etc.).
  • Reviews and updates the audit tools based on payer audits to ensure compliance.
  • Complete all required documentation and data entry of client's outcomes as outlined in the appropriate KMHS guidelines, manuals, policies, and procedures.
  • Attend all mandatory meetings and training on time and as scheduled.
  • In addition to the above, any other responsibilities assigned by the supervisor that are appropriate to the position and not specifically listed in the job description.

KMHS is an equal opportunity employer that does not discriminate against people regardless of age, genetic information, national origin, race/color, ethnicity, gender identity, sexual orientation, neurodiversity, disability, or veteran status. KMHS envisions an anti-racist, equitable, inclusive, and collaborative community in which all can feel welcome.

Benefits:
  • Comprehensive and generous health, dental and vision benefits
  • Up to 19 days of PTO and 8 paid holidays your first year (pro-rated for part-time)
  • An incredible team approach that is dynamic and collaborative
  • Loan Forgiveness, training, and extensive education available
  • Multiple locations and opportunities close to home
  • Advancement opportunities available within the agency
  • Free Employee Assistance Program and parking
  • Full Time, Part Time and PRN positions along with flexible hours for professional advancement


Qualifications

Minimum Qualifications:

EDUCATION: Bachelor's Degree in any field OR Equivalent combination of education, training, and experience.

EXPERIENCE: Experienced (minimum 2 years of job-related experience)

Minimum of 2 years experience working in psychiatric or mental health settings.

Possess and maintain a valid driver's license with an acceptable motor vehicle report.

Preferred Qualifications:

EDUCATION: Master's Degree in nursing, social work, or behavioral health field.

EXPERIENCE: Experienced (minimum 4 years of job-related experience)

Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.