Job Title: Utilization Review (UR) Coordinator / Authorization Representative [Clinical Experience Preferred] – Behavioral Health
Employment Type: Full-Time
Schedule: In-office, Monday through Friday
Position Overview
We are seeking a detail-oriented and highly organized Utilization Review (UR) Coordinator / Authorization Representative [clinical experience preferred]. This role is responsible for managing authorizations, ensuring medical necessity documentation, and maintaining compliance with AHCCCS (Arizona Health Care Cost Containment System) requirements.
The ideal candidate thrives in a fast-paced environment, demonstrates strong knowledge of behavioral health utilization management, and has a proven ability to manage high client volumes while maintaining strict adherence to timely filing and regulatory standards.
Key Responsibilities
- Obtain, track, and manage initial and concurrent authorizations for behavioral health services
- Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and medical necessity criteria
- Submit timely and accurate authorization requests, ensuring adherence to payer-specific timely filing requirements
- Monitor authorizations for expiration and proactively manage concurrent reviews to prevent gaps in coverage
- Communicate effectively with clinical staff, payers, and case managers to gather necessary documentation and ensure continuity of care
- Maintain accurate and up-to-date records in the EHR and authorization tracking systems
- Review clinical documentation for completeness and alignment with medical necessity standards
- Manage a high volume of client cases, prioritizing tasks to meet deadlines and avoid service disruptions
- Follow up on pending authorizations, denials, and appeals as needed
- Ensure compliance with all federal, state, and AHCCCS regulations, as well as internal policies and procedures
Qualifications
- Minimum of [2+] years of experience in utilization review, authorizations, or behavioral health administration
- Clinical experience (peer service, clinician, etc.) that could aid in the review of clinical necessity.
- 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
Preferred Qualifications
- 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
Compensation
- Pay Range: $24–$29 per hour (DOE)
Key Competencies
- Time management and prioritization
- Accuracy and compliance-driven mindset
- Critical thinking and problem-solving
- Ability to handle sensitive information with confidentiality (HIPAA compliance)
- Adaptability in a high-volume, deadline-driven environment
Why Join Us
- Opportunity to make a meaningful impact in behavioral health care
- Collaborative and mission-driven team environment
- Competitive compensation and benefits package
- Professional growth and development opportunities
Note: This position requires strict adherence to AHCCCS guidelines, timely filing requirements, and all applicable regulatory standards. Candidates must demonstrate the ability to manage multiple concurrent authorizations while maintaining accuracy and compliance.
