Utilization Review (UR) Coordinator / Authorization Representative [Clinical Experience Preferred] – Behavioral Health
$49,920–$60,320 year
On-sitePhoenix, Arizona, United States
Job Summary
Obtain, track, and manage initial and concurrent authorizations for behavioral health services while ensuring compliance with AHCCCS guidelines and medical necessity criteria. Submit timely authorization requests, monitor for expiration, and proactively manage concurrent reviews to prevent coverage gaps. Coordinate with clinical staff, payers, and case managers to gather documentation, review clinical records for completeness, and follow up on denials or appeals as needed. Maintain accurate records in EHR systems and adhere to federal, state, and internal policies. Manage high client volumes and prioritize tasks to meet deadlines. Full-time, in-office Monday through Friday.
Required Qualifications
- Minimum of [2+] years of experience in utilization review, authorizations, or behavioral health administration
- 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
- Background Check: All offers of employment are contingent upon the successful completion of a background check
- Drug Screening: Candidates must pass a drug screening test as a condition of employment
- APS Registry: Candidates must pass an APS (Adult Protective Services) registry check before an offer of employment can be extended
- By applying for this position, you acknowledge and consent to these procedures
Desired Qualifications
- Clinical experience (peer service, clinician, etc.) that could aid in the review of clinical necessity
- 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-peers
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