{"id":1751268,"url":"https://alion.io/job/canopy-childrens-solutions-utilization-review-coordinator-cares-jackson-ms","title":"Utilization Review Coordinator - CARES - Jackson, MS","company":{"id":2213309,"name":"Canopy Children's Solutions","domain":"mycanopy.org","url":"https://alion.io/company/mycanopy","size_band":"501-1000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"UltiPro","truth_index":{"grade":"B","score":75,"open_postings":5,"ghost_share":0,"stale_share":1,"repost_share":0,"time_to_fill_p50_days":null,"computed_at":"2026-10-21T05:46:15Z"}},"role":"Administrative","role_family":"Administrative","seniority":"junior","employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Jackson, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":36000,"max_usd":64000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":4005},"experience_years_min":2,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-08-31T13:54:15Z","employer_posted_date":"2026-08-31","last_verified_at":"2026-10-21T08:11:10Z","board_verified":true,"closed_at":null,"days_open":50,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":50},"description":"Founded in 1912 as an adoption agency, Canopy Children's Solutions is Mississippi’s most comprehensive nonprofit provider of children’s behavioral health, educational, and family support solutions. Canopy employs a diverse group of mission-driven individuals committed to honoring the voice of Mississippi children and families. Being an integral part of the Canopy team involves committing to the Core Values that drive our organization forward:\nThe voice of our children and families always comes first\nRelationships matter and our differences make us stronger\nWe take great joy in service to others\nOur families and our communities deserve our very best\nCanopy has been recognized as a Great Place to Work® for the fifth consecutive year and is one of only nine companies in Mississippi to earn this certification for 2025-2026. At Canopy, employees are committed to fostering a healthy workplace culture built on trust and driven by a shared mission: helping children thrive and empowering families to overcome extraordinary challenges.\nWe offer a comprehensive benefits package for all eligible full-time employees. Benefits include, but are not limited to:\nCompetitive Compensation\n403b Retirement Plan with Match\nMedical, Dental, Vision Insurance\nPTO/Vacation\nEmployee Wellness Program and Counseling Services\nUtilization Review Coordinator - Position Overview:\nThe Utilization Review Coordinator acts as a liaison between the organization and the Peer Review Organization (PRO), the physicians, the Interdisciplinary Treatment Team, the Managed Care Organization and Administration.\nThis position coordinates the utilization management of behavioral health services for all programs requiring pre-certification for admission. \nThe Utilization Review Coordinator coordinates all aspects of the concurrent review process and discharge process in collaboration with the assigned clinical staff.\nParticipates in the organization’s performance improvement and quality compliance process.\nRequired Physical & Environmental Requirements:\nRequired Physical Activities: sitting, standing, walking, reaching, pushing, pulling, grasping, lifting, talking, seeing, hearing, kneeling, stooping, bending, reaching overhead, and climbing stairs as needed and repetitive motions. Must have the physical ability to assist in the physical or therapeutic hold of youth when required, following organization approved safety protocols.\nCharacteristics of Work: frequent standing and walking, occasional sitting, lifting and carrying objects up to 50 pounds. Must be able to respond quickly to emergencies and physically assist or support youth and/or staff.\nVision Requirements: Close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.\nEnvironmental Conditions: This job requires exposure to both inside and outside weather conditions; the typical noise level for the work environment is moderate to loud noise. \nJob Responsibilities:\nAdministrative Functions:\nAssists in coordinating the interdisciplinary treatment teams.\nAttends staffing, treatment team meetings and clinical communities as applicable for coordination of care and transitional planning for aftercare/discharge services.\nReviews, evaluates and reports prior authorization, concurrent reviews, and discharges as required by the Peer Review Organization (PRO) and Managed Care Organizations (MCOs) for review.\nActs as the utilization liaison to the Managed Care Organizations, the Division of Medicaid and its Peer Review Organization (PRO) to facilitate the prior authorization process as needed.\nUtilizes clinical documentation from the electronic health records for children and youth to request concurrent reviews, extensions of using the prior authorization process.\nFacilitates the prior authorization and continued stay process and coordinate the review of required documentation with the Medical Director, Psychiatrists, and clinical teams assigned to obtain approval for concurrent reviews and continued stays through the prior authorization process for the PRO and Third Party Payers.\nManages required upload of required documentation to external reviewer sites for the purpose of supporting the prior authorization approval and lock in process.\nCoordinates discharge planning with the solution/clinical team to ensure timely discharges.\nConducts weekly verification of insurance and eligibility checks and notify solution staff and Director as applicable of status. Input verification documentation in the electronic health record.\nAssists in resolving billing holds and reimbursement errors as requested and needed by the accounting/billing department related to prior authorization approvals.\nFacilitates the clinical review of the appeal process for denials of concurrent reviews as needed, if applicable.\nAssists in the development of policies and procedures related to utilization management, treatment planning, concurrent reviews and discharges as necessary.\nAssures that all processes and documentation meet Division of Medicaid, PRO, Third Party Payers and the organization’s standards by reviewing records and clinical documentation for compliance and quality assurance.\nMonitors authorizations approvals for upcoming expiration to facilitate either a discharge or concurrent review using utilization management reports in the electronic health record.\nMonitors medical necessity criteria regularly and facilitate the utilization management process.\nAnalyzes patient records to determine legitimacy of admission and treatment in accordance with the external reviewers and regulatory organizations’ medical necessity criteria.\nProvides coverage for admissions staff duties as assigned and requested to ensure overall work goals are accomplished within the department.\nMaximizes revenue by tracking and managing reimbursement issues; identifying and recommending potential opportunities; and preventing revenue-reducing clerical errors.\nPromotes Canopy Children’s Solutions to the public.\nAppropriately utilize and accept supervision.\nPromotes the organization's Core Values and Mission.\nAdheres to identified and established work schedule.\nPerforms other responsibilities and duties as requested and/or assigned by the Director of Admissions and/or Leadership.\nAdheres to organizational policies and procedures.\nMeets all key performance indicators (KPI).\nProvides weekly reports on service delivery and utilization of services for identified solutions within the organization to the Director of Admissions and upon request as needed.\nProvides prior authorization status, utilization reports, and eligibility status reports to Director of Admissions, admissions team, and solution team weekly and upon request as needed.\nProvides status update of any cases in appeal as applicable to Director of Admissions and admissions department staff and solution staff assigned as needed and requested.\nProvides monthly reporting of quality review samples for auditing.\nRequired Qualifications:\nValid and current mental health Certification (PCMHT or CMHT) and/or license (LPC, LCSW, LMSW, LMFT, LMFTA) within 30 days of employment.\nMinimum of a Bachelor's degree requiring an LSW or Master’s degree in a social science field such as Counseling, Psychology, Social Work or a social rehabilitative field.\n\nMinimum of two (2) years' experience in a behavior health setting.\nMinimum one (1) year of experience working with children and 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