Utilization Review Coordinator

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🔥 3 minutes ago

🏄 California, Washington – Remote

🏄 California – Remote ☕ Washington – Remote

💵 $70k - $80k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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COPA - The Colorado Providers Association

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 1994

⚕️ Healthcare Insurance

🌍 Social Impact

🤝 Non-profit

Healthcare Insurance • Social Impact • Non-profit

COPA - The Colorado Providers Association is a member-focused organization dedicated to advocating for behavioral health and substance use care for the residents of Colorado. The association strives to elevate the voices of prevention, treatment, and recovery providers to ensure equitable access to care and improve outcomes for individuals facing substance use disorders and related behavioral health needs. Through legislative support, training, and resources, COPA works to foster a connected community among its members and enhance the overall quality of care available in the state.

📋 Description

• Reporting directly to the Director of Revenue Cycle Management. • Handling pre-certifications, authorizations, retro-authorizations, appeals, medical records requests, and chart auditing duties. • Partner closely with clinical and revenue cycle teams to remove administrative barriers. • Conduct live reviews with payors and level of care chart reviews. • Clinically negotiate authorization outcomes with the payor. • Provide guidance and training to clinicians on completing P2P reviews. • Timely completion of the Denial Notification process.

🎯 Requirements

• Bachelor's degree in Social Work, Nursing, or any related field. • Must be based in PST, with an understanding of the west coast Payer landscape, specifically CA or WA. • 2-3+ years of UR experience in behavioral health, ideally across PHP or IOP levels of care. • Knowledge of medical necessity criteria, payer authorization processes, documentation standards, and regulatory requirements. • Proficient in MS Office applications and ability to learn department and job-specific software systems. • Strong organizational, communication, analytical, and problem-solving skills with exceptional attention to detail.

🏖️ Benefits

• Medical, dental, vision, HealthJoy unlimited therapy, UHC wellness program, HSA/FSA options, and pet insurance. • Responsible PTO, in lieu of a traditional accrual-based policy. • 401(k) with company match. • All licensing fees covered. • Annual stipend for tuition reimbursement, ongoing education, or CEUs. • Pre-licensed clinicians receive structured clinical supervision toward licensure.