San Marcos Treatment Center has an excellent career opportunity for an experienced UTILIZATION REVIEW CLINICAL MANAGEMENT COORDINATOR to join our dedicated clinical team, providing services to short-term commercial managed care, Medicaid/State Agency and Tricare-funded patients ages 7-18 with psychiatric, neuropsychiatric or neurodevelopmental issues and their families.
Understands and navigates LOCAT criteria utilized by managed care. Conducts utilization reviews; complies clinical reports and demonstrates success securing continued coverage/authorization for patients. Prepares and submits appeals of denials. Demonstrates an ability to organize and efficiently implement all service as required in the areas of concurrent and retrospective reviews on open and closed cases and responds appropriate and effectively to exceptional and unusual/non-routine occurrences as they arise.