Full-time - UR Coordinator

About the Organization

Lakeside Behavioral Health System, established in 1969, is the premier provider of specialized behavioral health and addictive disease services in the Memphis and Mid-South region. Our 365-bed facility is one of the largest free-standing psychiatric hospitals in the United States, located on a serene 37-acre campus in northeast Shelby County. We serve children, adolescents, young adults, adults, and seniors, offering comprehensive programs for disorders such as bipolar disorder, psychological trauma, depression, anxiety, mental illness, and addictive diseases including alcoholism, drug addiction, and substance abuse.

Lakeside is part of Universal Health Services, Inc. (UHS), a Fortune 500 corporation with annual revenues of $14.3 billion in 2023. UHS operates acute care hospitals, behavioral health facilities, outpatient centers, and related services across the U.S., Washington, D.C., Puerto Rico, and the United Kingdom.

About the Role

The Utilization Management (UM) Coordinator evaluates patient medical records to determine the severity of illness and appropriateness of the level of care. This role serves as a liaison between patients, the hospital, and insurance companies, advocating for patient length of stay and level of care. The UM Coordinator oversees utilization review activities, ensures reimbursement for hospital services, and facilitates physician weekly staffing meetings. Additionally, they coordinate with physicians' outpatient offices for billing purposes and manage patient benefits with a working knowledge of all levels of care offered.

Responsibilities

• Evaluate patient medical records to assess severity of illness and determine appropriateness of level of care.
• Serve as liaison between patients, hospital, and insurance companies; negotiate and advocate for patient length of stay and level of care.
• Oversee utilization review activities with other departments to ensure reimbursement for hospital services.
• Facilitate physician weekly staffing meetings and coordinate with physicians' outpatient offices for billing purposes.
• Manage patient benefits with a working knowledge of all levels of care offered by the hospital.

Requirements

• Master’s-prepared healthcare professional (Nursing, Counseling, Psychology, or Social Work) or Registered Nurse.
• Minimum of 3-5 years of direct psychiatric patient care experience.
• Valid Tennessee RN license, LCSW, or LPC preferred.
• Knowledge of psychiatric care, utilization review, insurance reimbursement procedures, and DSM-V.

Skills

• Advanced computer skills.
• Strong analytical, organizational, verbal, and written communication skills.

Benefits

• Competitive compensation.
• Comprehensive benefits package.
• Opportunities for advancement.
• Tuition assistance.
• Paid time off.