Utilization Review (UR) / Utilization Management (UM) Coordinator
About the Role
Turning Point Care Center provides comprehensive behavioral health care for adults experiencing chemical dependency, acute psychiatric disorders, or a dual diagnosis. For more than 40 years, our team has provided a place of healing and hope through a full continuum of inpatient and outpatient care, with programs tailored to meet each patient’s unique needs. Nestled in a serene, rural setting in Moultrie, Georgia, Turning Point offers a calming, secure environment where patients can focus on recovery and build a foundation for lifelong wellness.
Centrally located in South Georgia, our facility is just 30 minutes from I-75, 1.5 hours north of Tallahassee, 3 hours south of Atlanta, and 2.5 hours west of Jacksonville.
Responsibilities
- Conduct concurrent and extended-stay reviews using ASAM criteria and DSM-5 guidelines to determine medical necessity, appropriateness of care, continued stay, and discharge criteria
- Collaborate with Admissions, Clinical Staff, Nursing, Medical Records, Business Office, and providers to address insurance issues and communicate patient information and benefits
- Review patient records, treatment plans, and clinical status; communicate pertinent third-party payor requirements and acuity concerns to physicians and the treatment team
- Perform clinical reviews with insurance case managers by telephone and electronically while maintaining positive working relationships with third-party payors
- Maintain accurate and timely documentation in MIDAS and other Utilization Management records; run and interpret reports as needed
- Prepare and submit timely appeals to third-party payors, working with the Business Office and treatment team to gather supporting documentation
- Attend treatment team and AR/Denials meetings and maintain records in accordance with applicable policies, regulatory requirements, and accreditation standards
Requirements
- Licensed through state board for Nursing or Counseling/Therapy
- RN, LMSW, LAPC, or LAMFT required; BSN, MSN, LCSW, LPC, or LMFT preferred
- Three years’ experience in chart analysis, utilization review, medical/clinical terminology, and acuity of illness
- Knowledge and understanding of a variety of insurances including Traditional Medicare, Medicare Advantage Plans, and Commercial Plans
- Knowledge and experience with chemical dependency and mental health programs, situational evaluations, and crisis intervention preferred
Benefits
- Competitive compensation & generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Tuition savings to continue your nursing education with Chamberlain University
- Career development opportunities within UHS and its 300+ Subsidiaries
- Pet Insurance
More information is available on our Benefits Guest Website.
About the Employer
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.
Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network, and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico, and the United Kingdom.