Utilization Review (UR) Coordinator / Authorization Representative [Clinical Exp
Sanctuary Recovery Centers, Phoenix, AZ, United States
Job Title:
Utilization Review (UR) Coordinator / Authorization Representative [Clinical Experience Preferred] - Behavioral Health
Employment Type:
Full-Time
Schedule:
In-office, Monday through Friday
Position Overview
We are seeking a detail-oriented and highly organized Utilization Review (UR) Coordinator / Authorization Representative [clinical experience preferred]. This role is responsible for managing authorizations, ensuring medical necessity documentation, and maintaining compliance with AHCCCS (Arizona Health Care Cost Containment System) requirements. The ideal candidate thrives in a fast-paced environment, demonstrates strong knowledge of behavioral health utilization management, and has a proven ability to manage high client volumes while maintaining strict adherence to timely filing and regulatory standards.
Key Responsibilities
Obtain, track, and manage initial and concurrent authorizations for behavioral health services
Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and medical necessity criteria
Submit timely and accurate authorization requests, ensuring adherence to payer-specific timely filing requirements
Monitor authorizations for expiration and proactively manage concurrent reviews to prevent gaps in coverage
Communicate effectively with clinical staff, payers, and case managers to gather necessary documentation and ensure continuity of care
Maintain accurate and up-to-date records in the EHR and authorization tracking systems
Review clinical documentation for completeness and alignment with medical necessity standards
Manage a high volume of client cases, prioritizing tasks to meet deadlines and avoid service disruptions
Follow up on pending authorizations, denials, and appeals as needed
Ensure compliance with all federal, state, and AHCCCS regulations, as well as internal policies and procedures
Qualifications
Minimum of 2+ years of experience in utilization review, authorizations, or behavioral health administration
Clinical experience (peer service, clinician, etc.) that could aid in the review of clinical necessity
Strong working knowledge of AHCCCS requirements, including authorization processes and compliance standards
Experience with timely filing requirements and payer-specific guidelines
Proven ability to manage high caseloads and concurrent reviews in a fast-paced environment
Familiarity with behavioral health levels of care (e.g., RTC, PHP, IOP, outpatient)
Excellent organizational skills and attention to detail
Strong written and verbal communication skills
Experience with EHR systems and authorization tracking tools
Ability to work independently and as part of a multidisciplinary team
Preferred Qualifications
Experience working with Medicaid/managed care plans, specifically AHCCCS
Knowledge of InterQual, ASAM, or other medical necessity criteria tools
Previous experience handling denials, appeals, and peer-to-peer reviews
Compensation
Pay Range: $24-$29 per hour (DOE)
Key Competencies
Time management and prioritization
Accuracy and compliance-driven mindset
Critical thinking and problem-solving
Ability to handle sensitive information with confidentiality (HIPAA compliance)
Adaptability in a high-volume, deadline-driven environment
Why Join Us
Opportunity to make a meaningful impact in behavioral health care
Collaborative and mission-driven team environment
Competitive compensation and benefits package
Professional growth and development opportunities
Note: This position requires strict adherence to AHCCCS guidelines, timely filing requirements, and all applicable regulatory standards. Candidates must demonstrate the ability to manage multiple concurrent authorizations while maintaining accuracy and compliance.
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Utilization Review (UR) Coordinator / Authorization Representative [Clinical Experience Preferred] - Behavioral Health
Employment Type:
Full-Time
Schedule:
In-office, Monday through Friday
Position Overview
We are seeking a detail-oriented and highly organized Utilization Review (UR) Coordinator / Authorization Representative [clinical experience preferred]. This role is responsible for managing authorizations, ensuring medical necessity documentation, and maintaining compliance with AHCCCS (Arizona Health Care Cost Containment System) requirements. The ideal candidate thrives in a fast-paced environment, demonstrates strong knowledge of behavioral health utilization management, and has a proven ability to manage high client volumes while maintaining strict adherence to timely filing and regulatory standards.
Key Responsibilities
Obtain, track, and manage initial and concurrent authorizations for behavioral health services
Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and medical necessity criteria
Submit timely and accurate authorization requests, ensuring adherence to payer-specific timely filing requirements
Monitor authorizations for expiration and proactively manage concurrent reviews to prevent gaps in coverage
Communicate effectively with clinical staff, payers, and case managers to gather necessary documentation and ensure continuity of care
Maintain accurate and up-to-date records in the EHR and authorization tracking systems
Review clinical documentation for completeness and alignment with medical necessity standards
Manage a high volume of client cases, prioritizing tasks to meet deadlines and avoid service disruptions
Follow up on pending authorizations, denials, and appeals as needed
Ensure compliance with all federal, state, and AHCCCS regulations, as well as internal policies and procedures
Qualifications
Minimum of 2+ years of experience in utilization review, authorizations, or behavioral health administration
Clinical experience (peer service, clinician, etc.) that could aid in the review of clinical necessity
Strong working knowledge of AHCCCS requirements, including authorization processes and compliance standards
Experience with timely filing requirements and payer-specific guidelines
Proven ability to manage high caseloads and concurrent reviews in a fast-paced environment
Familiarity with behavioral health levels of care (e.g., RTC, PHP, IOP, outpatient)
Excellent organizational skills and attention to detail
Strong written and verbal communication skills
Experience with EHR systems and authorization tracking tools
Ability to work independently and as part of a multidisciplinary team
Preferred Qualifications
Experience working with Medicaid/managed care plans, specifically AHCCCS
Knowledge of InterQual, ASAM, or other medical necessity criteria tools
Previous experience handling denials, appeals, and peer-to-peer reviews
Compensation
Pay Range: $24-$29 per hour (DOE)
Key Competencies
Time management and prioritization
Accuracy and compliance-driven mindset
Critical thinking and problem-solving
Ability to handle sensitive information with confidentiality (HIPAA compliance)
Adaptability in a high-volume, deadline-driven environment
Why Join Us
Opportunity to make a meaningful impact in behavioral health care
Collaborative and mission-driven team environment
Competitive compensation and benefits package
Professional growth and development opportunities
Note: This position requires strict adherence to AHCCCS guidelines, timely filing requirements, and all applicable regulatory standards. Candidates must demonstrate the ability to manage multiple concurrent authorizations while maintaining accuracy and compliance.
#J-18808-Ljbffr