Utilization Review Coordinator - CARES - Jackson, MS

About the Organization

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. Core Values that drive the organization forward include:

• The voice of our children and families always comes first
• Relationships matter and our differences make us stronger
• We take great joy in service to others
• Our families and our communities deserve our very best

Canopy 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. Employees foster a healthy workplace culture built on trust and driven by a shared mission: helping children thrive and empowering families to overcome extraordinary challenges.

About the Role

The Utilization Review Coordinator acts as a liaison between the organization and the Peer Review Organization (PRO), physicians, the Interdisciplinary Treatment Team, the Managed Care Organization, and Administration. This position coordinates the utilization management of behavioral health services for all programs requiring pre-certification for admission, including all aspects of the concurrent review process and discharge process in collaboration with assigned clinical staff. The role also participates in the organization’s performance improvement and quality compliance process.

Responsibilities

• Assists in coordinating the interdisciplinary treatment teams.
• Attends staffing, treatment team meetings, and clinical communities as applicable for coordination of care and transitional planning for aftercare/discharge services.
• Reviews, evaluates, and reports prior authorization, concurrent reviews, and discharges as required by the Peer Review Organization (PRO) and Managed Care Organizations (MCOs) for review.
• Acts 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.
• Utilizes clinical documentation from electronic health records for children and youth to request concurrent reviews and extensions using the prior authorization process.
• Facilitates the prior authorization and continued stay process, coordinating the review of required documentation with the Medical Director, Psychiatrists, and clinical teams to obtain approval for concurrent reviews and continued stays.
• Manages the required upload of documentation to external reviewer sites to support prior authorization approval and lock-in processes.
• Coordinates discharge planning with the solution/clinical team to ensure timely discharges.
• Conducts weekly verification of insurance and eligibility checks, notifying solution staff and Director as applicable of status, and inputs verification documentation in the electronic health record.
• Assists in resolving billing holds and reimbursement errors related to prior authorization approvals as requested by the accounting/billing department.
• Facilitates the clinical review of the appeal process for denials of concurrent reviews as needed.
• Assists in the development of policies and procedures related to utilization management, treatment planning, concurrent reviews, and discharges.
• Ensures all processes and documentation meet Division of Medicaid, PRO, Third Party Payers, and organizational standards by reviewing records and clinical documentation for compliance and quality assurance.
• Monitors authorization approvals for upcoming expiration to facilitate either discharge or concurrent review using utilization management reports in the electronic health record.
• Monitors medical necessity criteria regularly and facilitates the utilization management process.
• Analyzes patient records to determine legitimacy of admission and treatment in accordance with external reviewers and regulatory organizations’ medical necessity criteria.
• Provides coverage for admissions staff duties as assigned to ensure overall work goals are accomplished within the department.
• Maximizes revenue by tracking and managing reimbursement issues, identifying potential opportunities, and preventing revenue-reducing clerical errors.
• Promotes Canopy Children’s Solutions to the public.
• Appropriately utilizes and accepts supervision.
• Promotes the organization's Core Values and Mission.
• Adheres to identified and established work schedule.
• Performs other responsibilities and duties as requested by the Director of Admissions and/or Leadership.
• Adheres to organizational policies and procedures.
• Meets all key performance indicators (KPI).
• Provides weekly reports on service delivery and utilization of services for identified solutions within the organization to the Director of Admissions and upon request.
• Provides prior authorization status, utilization reports, and eligibility status reports to the Director of Admissions, admissions team, and solution team weekly and upon request.
• Provides status updates of any cases in appeal to the Director of Admissions, admissions department staff, and assigned solution staff as needed.
• Provides monthly reporting of quality review samples for auditing.

Requirements

Physical & Environmental Requirements

• Physical Activities: Sitting, standing, walking, reaching, pushing, pulling, grasping, lifting, talking, seeing, hearing, kneeling, stooping, bending, reaching overhead, climbing stairs, and repetitive motions as needed. Must have the physical ability to assist in the physical or therapeutic hold of youth when required, following organization-approved safety protocols.
• Characteristics 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.
• Vision Requirements: Close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Environmental Conditions: Exposure to both inside and outside weather conditions; typical noise level for the work environment is moderate to loud.

Qualifications

• Minimum of a Bachelor's degree required; Master's degree preferred in a social science field such as Psychology, Education, and/or Social Work or a social rehabilitative field.
• Minimum of two (2) years' experience in a behavioral health setting.
• Minimum one (1) year of experience working with children and adolescents.

Benefits

Canopy offers a comprehensive benefits package for all eligible full-time employees, including:

• Competitive Compensation
• 403b Retirement Plan with Match
• Medical, Dental, and Vision Insurance
• PTO/Vacation
• Employee Wellness Program and Counseling Services