RN Utilization Review Coordinator

RN Utilization Review Coordinator

Reports to: Medical Director

Job Category: Hourly Non-Exempt Full-Time

Starting Salary: $34-$51/hour (DOE and licensure)

Job Site: Hybrid (Broomfield CO office/Home office)

Job Summary:

The Registered Nurse (RN) Utilization Review Coordinator plays a critical role in overseeing the clinical admission process and ensuring appropriate utilization of detox and residential treatment services. This position serves as the clinical decision-maker for all incoming admissions verifying medical and psychiatric appropriateness reviewing clinical documentation and coordinating with referring providers intake staff and internal teams to ensure timely safe and clinically appropriate admissions. Additionally the RN manages ongoing utilization review (UR) to maintain compliance with payer requirements and to support quality client care throughout the treatment continuum.

Education and Experience:

• Current unrestricted nursing license in Colorado (registered with DORA).
• RN LPN Diploma Associates or Bachelors in Nursing; BSN preferred.
• Minimum two (2) years of experience in psychiatric behavioral health or substance use treatment.
• Strong knowledge of ASAM criteria and medical necessity standards for detox and residential levels of care.
• Prior experience with utilization review and insurance authorizations.
• Experience in a detox dual-diagnosis or residential treatment setting preferred.
• Familiarity with managed care requirements and UR software platforms preferred.
• BLS certification required.

Required Skills/Abilities:

• Valid non-restricted Colorado drivers license.
• Excellent clinical assessment documentation and communication skills.
• Ability to make sound clinical decisions under pressure and manage multiple priorities.
• Strong relationship building skills.
• Ability to listen well and offer solutions.
• Results driven with a proven track-record of meeting and exceeding defined goals.
• Ability to act with integrity professionalism and confidentiality.
• Strong collaboration skills with the ability to think creatively and share ideas.
• Ability to manage time effectively.
• Knowledge of industry and trauma-integrated care.
• Proficient with Google Workspace or related software.
• Proficiency with EHR systems and clinical documentation workflows.
• Must be available for on-call consultation for admission approvals as needed including evenings or weekends.

Duties/Responsibilities:

• Admissions Oversight:
  • Review all incoming admission referrals for clinical and medical appropriateness.
  • Approve or defer client admissions based on established medical and psychiatric criteria.
  • Collaborate with Intake Coordinators Milieu Managers and clinical staff to ensure safe and efficient client transitions into care.
  • Assess medical stability and risk factors prior to acceptance into detox or residential programs.
  • Communicate directly with referral sources payers and internal departments regarding admission status and required documentation.
  • Support intake team during high-volume periods to ensure smooth admissions flow.
• Utilization Review (UR):
  • Conduct concurrent and retrospective utilization reviews to ensure services meet payer and regulatory standards.
  • Prepare and submit clinical reviews and updates to insurance companies within required timeframes.
  • Track authorizations reauthorizations and service limits maintaining accurate and timely records.
  • Collaborate with clinical and billing teams to resolve authorization or coverage issues.
  • Participate in treatment planning discussions to ensure medical necessity and appropriate level of care are maintained.
• Clinical Support:
  • Provide nursing assessments medication reconciliation and clinical input as needed during the admission process.
  • Serve as a clinical resource to staff regarding psychiatric and detox-related care.
  • Maintain accurate and timely documentation in the electronic health record (EHR).
  • Maintains confidentiality and adheres to facility policies and procedures State & Federal law and accrediting agency regulations and standards.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Standing sitting bending reaching.
• Must be able to see hear talk read write type.
• Exposure to clinical and medical environments.
• Must be able to lift 15 pounds at times.
• Driving in all weather conditions.
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Benefits & Perks:

Health and Wellness

• Medical dental and vision insurance*
• Supplemental accident and hospital indemnity coverage*
• Voluntary Term Life insurance*
• Employee Assistance Program
• Monthly wellness reimbursement*

Financial

• Competitive salary
• Employee recognition and rewards programs
• Employee referral incentive program
• Employer-sponsored 401(k) plan

Work/Life Perks

• Professional growth and development
• Continuing education reimbursement
• Unlimited paid time off (exempt employees) sick days
• Paid time off policy (non-exempt employees) sick days
• Paid holidays (exempt) or ability to earn 1.5x base hourly rate (non-exempt)

*Full-time employees

This description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities required. Duties responsibilities and activities may change or new ones may be assigned at any time with or without notice.