Utilization review nurse Jobs in Aurora, CO

Job Description

Job Description

Position : Utilization Review Coordinator

Job Type : Full Time

Location : Remote

Schedule : Monday to Friday 8 : 30am to 5 : 00pm

Compensation : $26-29 Per Hour

About The Role

The Utilization Review Coordinator (UR Coordinator) plays a crucial role in managing all utilization reviews for Sandstone Care's detox, residential, partial hospitalization, intensive outpatient, and outpatient programs. This position involves conducting pre-authorization and concurrent reviews of medical records to ensure that admission criteria, treatment plans, and continued stays align with industry standards and support timely discharge planning. The UR Coordinator facilitates communication between third-party payers and clinical staff, ensuring that medical records accurately reflect the intensity and level of services provided. This role is integral in maintaining compliance with Joint Commission, federal, and state regulations.

Key Responsibilities :

• Manage pre-authorization requests and concurrent reviews by analyzing insurance, governmental, and accrediting agency standards for admissions, treatment, and length of stay.
• Collaborate with clinical and medical personnel to determine appropriate length of stay and ensure documentation meets criteria.
• Ensure compliance with clinical program policies, collaborating with the Clinical Director and Program Manager to implement necessary quality improvements.
• Support therapeutic services by conducting assessments, treatment planning, and coordinating clinical services with families, ensuring timely documentation for billing.
• Lead weekly clinical meetings to discuss utilization review, treatment progress, discharge planning, and follow-up care.
• Participate in recruiting competent clinicians to provide high-quality mental health and substance abuse services.
• Maintain effective communication with families, referral agencies, and other community resources, fostering strong public relations.
• Demonstrate strong decision-making skills, emotional stability, and judgment under pressure, ensuring a positive and supportive environment for both clients and staff.

Qualifications :

Ability to analyze medical records and make informed decisions regarding admissions and treatment plans.

Other Requirements :

The Perks

At Sandstone Care, we believe that great care starts with our employees. That's why we offer a comprehensive benefits package to support you in your personal and professional journey. Some of the benefits include :

What to Expect : Our Interview Process

Here's an overview of what comes next :

Expected Interview Timeline : The entire process typically takes 2-3 weeks.

Sandstone Care's Commitment to Diversity, Equity, & Inclusion

At Sandstone Care, we are committed to fostering a culture of diversity, equity, and inclusion that not only enriches the lives of our employees but also ensures the wellbeing and care of our clients, regardless of their race, ethnicity, gender identity, sexual orientation, socioeconomic status, age, ability, or background. We believe that embracing diversity and promoting equity and inclusion are integral to our mission of providing high-quality behavioral health services.

Sandstone Care is an equal opportunity employer and prohibits discrimination and harassment of any kind. We are committed to creating a diverse and inclusive workplace where all employees feel valued, respected, and empowered. We do not discriminate based on race, color, religion, creed, age, sex, national origin, ancestry, marital status, veteran status, sexual orientation, gender identity, disability, or any other legally protected status. All employment decisions are based on qualifications, merit, and business needs.