Utilization Review Coordinator

Job Title: Utilization Review Coordinator
Company: Exceptional Wellness Inc.
Location: Sugarland, TX
Pay: $18.00 per hour
Job Type: Full-Time / Part-Time (adjust as needed)

Job Summary:

Exceptional Wellness Inc. is seeking a detail-oriented and organized Utilization Review Coordinator to join our growing team. This role is responsible for ensuring all clinical documentation meets compliance, billing, and payer requirements. The ideal candidate has experience in mental health services, strong attention to detail, and a solid understanding of documentation standards.

Key Responsibilities:

• Review clinical documentation (SOAP notes, treatment plans, assessments) for accuracy, completeness, and compliance
• Ensure documentation aligns with Medicaid, TRR, TAC, and payer guidelines
• Monitor timeliness of documentation (e.g., 48-hour note completion requirement)
• Identify errors, missing information, or non-compliant documentation and communicate corrections to staff
• Conduct internal audits of client records and services
• Track and follow up on expiring authorizations, treatment plans, and assessments
• Assist with recertifications and ensure all required documentation is completed
• Collaborate with QMHPs, supervisors, and administrative staff to maintain compliance
• Maintain organized records and reports of audits and findings
• Provide feedback and guidance to staff to improve documentation quality

Qualifications:

• Experience in mental health, case management, or behavioral health setting preferred
• Knowledge of Medicaid documentation standards, TRR, and TAC strongly preferred
• Strong attention to detail and organizational skills
• Ability to review and interpret clinical documentation
• Excellent communication and follow-up skills
• Ability to work independently and meet deadlines
• Proficient in EMR systems (TheraNest or similar preferred)

Preferred Skills:

• Experience with audits, compliance, or quality assurance
• Understanding of medical necessity and level of care guidelines
• Ability to identify billing risks and documentation issues

Why Join Exceptional Wellness?

• Growing organization with opportunities for advancement
• Supportive and team-oriented environment
• Opportunity to make a direct impact on quality of care and compliance

Pay: $18.00 per hour

Work Location: In person