Utilization Review Coordinator

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 include managing pre-authorization requests and concurrent reviews, collaborating with clinical and medical personnel, ensuring compliance with clinical program policies, and supporting therapeutic services by conducting assessments and coordinating clinical services. The role also involves leading weekly clinical meetings and maintaining effective communication with families and referral agencies.