Utilization Review Coordinator

Utilization Review Coordinator

Lakeview Health has helped thousands of people detox, recover and remain abstinent from dangerous substances. We strive to be the best in the addiction treatment field through our proven treatment programs, experienced staff, and amenity-rich campus. At Lakeview Health, we deliver experiences designed by the best team of caregivers in the nation. Through our aftercare program, we are able to extend lasting support to our alumni community.

We are seeking a Utilization Review Coordinator to add to our dynamic team. The Utilization Review Coordinator plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of patient records, treatment plans, and clinical data to determine the appropriateness of care and resource utilization. This position collaborates closely with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes. By applying clinical knowledge and regulatory guidelines, the role helps control healthcare costs while maintaining high-quality patient care. Ultimately, the Utilization Review Coordinator contributes to the integrity and sustainability of healthcare delivery systems across the United States.

Responsibilities

• Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services
• Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details
• Make informed decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements
• Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards
• Stay current with evolving healthcare regulations, payer policies, and clinical best practices to ensure consistent and compliant review processes

Minimum Qualifications

• Bachelor's degree in a healthcare or related field
• At least 2 years of experience in utilization review, case management, or clinical healthcare roles
• Strong knowledge of medical terminology, clinical procedures, and healthcare regulations
• Familiarity with insurance authorization processes and healthcare reimbursement models
• Excellent analytical, communication, and organizational skills

Preferred Qualifications

• Experience with electronic health records (EHR) systems and utilization management software
• Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager)
• Prior experience working with managed care organizations or insurance companies
• Advanced knowledge of Medicare, Medicaid, and other payer-specific guidelines