Challenges Of A Utilization Review Coordinator

Challenges of a Utilization Review Coordinator

Many treatment centers, both for-profit and not-for-profit, have discovered that onboarding an experienced Utilization Review Coordinator bridges the gap between Admissions, Accounting, and Clinical departments. Having a trained staff member that can interact with a payer and provide documentation of medical necessity is one of the wisest staffing decisions a facility can make. If you are frustrated with poor results from having an outside billing company fill these shoes consider what it takes to have that person on staff. This does not mean you have to do your own billing, but it does pave the way to control a bit more of the outcome.

What Documentation Helps

A Behavioral Health and Addiction Treatment specialty-specific electronic health record system should include features to support a strong, results-driven UR department. Reports and Alerts should include:

  • Census Report
  • Appointments Report
  • Authorization Report
  • Referral Alert
  • Review Date Alert
  • Medications and Vitals, current and historical
  • Medical Documentation Templates developed and reviewed by Joint Commission experts
  • Chronological Documentation of medical and clinical services, that can support days and time spent on group or individual sessions
  • Medical Records Fax quickly and directly from the patient record

Instead of manually creating them in excel or word, having an electronic system that delivers the data needed in real-time can dramatically speed the communication between payer and treatment center for the benefit of those you serve.

Patient Care

As many treatment centers and agencies are out-of-network treatment providers, bridging the gap between admissions, accounting and clinical departments with an in-house UR person is crucial as they interact daily with the medical and clinical staff. Additionally, they are an important advocate for patients with their payers.

Whether you serve Detox, RES, PHP, IOP, or OP, adolescents or adults, today’s specialty specific EHRs should serve the needs and requirements of all departments. Having Practice Management and Revenue Cycle Management built into the system affords an all-in-one solution while holding down costs and improving business outcomes to support the best clinical care.

When you are considering a system upgrade, consider AZZLY® Rize™. Built for Clinical, Medical, Admissions and Accounting Departments. For fewer clicks, simplified documentation, and comprehensive view to achieving better outcomes call (888) 400-3201 or visit