Utilization Review Coordinator
Location(s): Pasadena, CA
Job Type: Full-Time
We are a leading mental health clinic specializing in innovative depression treatments, including Transcranial Magnetic Stimulation (TMS) and Spravato (esketamine) therapy. We’re seeking a reliable, patient-focused technician to join our team in delivering exceptional care with empathy, professionalism, and clinical precision.
Job Description
The Utilization Review Coordinator will manage all pre-authorizations, re-authorizations, and retroactive authorizations for TMS, Spravato, and related interventional psychiatric services. The role ensures timely approval of medically necessary services, prevents gaps in treatment due to authorization delays, optimizes reimbursement, and maintains payer compliance. This position will work closely with providers, clinical staff, intake, and billing teams to coordinate authorization processes from start to finish.
Key Responsibilities:
Pre-Authorization Management
- Submit and track prior authorization requests for new TMS and Spravato patients
- Verify clinical documentation meets payer medical necessity criteria
- Communicate authorization decisions to clinical and administrative teams
Re-Authorization Management
- Monitor patient treatment timelines to ensure re-authorizations are initiated in advance
- Prepare updated clinical summaries, progress notes, and outcome measures for payer review
Retroactive Authorization Requests
- Manage post-service authorization requests to capture missed approvals
- Work with billing to ensure claims are reprocessed after retroactive approval
Payer Communication & Compliance
- Serve as primary point of contact for insurance companies regarding authorizations
- Stay current on payer guidelines and updates for psychiatric interventions
- Ensure all processes comply with federal, state, and payer requirements
Data Tracking & Reporting
- Maintain logs of authorization status, turnaround times, and denial trends
- Provide monthly metrics to leadership on UR performance and revenue impact
Denial Management
- Confirming eligibility for patients receiving treatment
- Review and appeal denied authorizations with supporting clinical documentation
- Identify root causes of denials and collaborate with leadership to improve processes
Timeliness & Urgency
- Prioritize cases requiring immediate attention
- Proactively communicate and maintain a sense of urgency when coordinating
- Effectively manage time and caseload to meet team and organizational goals
Qualifications:
- Experience as a Medical Assistant, a bachelor's degree in nursing, social work, psychology, or a related field is encouraged but not required
- Previous experience in utilization review, case management, or behavioral health settings, particularly with TMS and Spravato therapies, is highly desirable
- Knowledge of insurance authorization processes, coding regulations (CPT, ICD-10), and payer requirements related to behavioral health
- Strong analytical skills and attention to detail, with the ability to assess clinical documentation effectively
- Excellent communication skills, both verbal and written, with the ability to collaborate effectively with clinical staff and external stakeholders
- Proficient in electronic health records (EHR) systems, Microsoft Office Suite, and customer relationship management (CRM) systems
Why Join Us?
- Work in a modern, patient-centered clinic with state-of-the-art technology
- Be part of a compassionate, supportive team dedicated to transforming lives
- Gain hands-on experience with innovative mental health treatments
- Receive thorough training and ongoing support to succeed in your role
We’re proud to be Southern California’s premier provider of cutting-edge depression treatments.
Learn more about us at www.socaltms.com
Job Type: Full-time
Pay: $28.00 - $30.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
