PHP Utilization Review Coordinator

North Spring Behavioral Healthcare, a subsidiary of Universal Health Services, Inc. (UHS), is a Department of Behavioral Health and Developmental Services (DBHDS)-licensed and Joint Commission-approved facility. We operate an 87-bed Psychiatric Residential Treatment Facility and a 40-bed Inpatient Acute Psychiatric Hospital on 42 acres in historic Leesburg, VA, approximately 25 miles northwest of Washington, D.C. Our therapeutic programs serve adolescents in a safe, secure environment focused on growth and self-responsibility.

About the role

The Utilization Review Coordinator assists admissions in screening patients at the pre-hospital level to ensure admission criteria are met. After admission, the coordinator reviews charts to confirm documentation aligns with admission, continued stay, and discharge criteria. This role involves interacting with clinical staff, the Business Office, Admissions, Medical Records, third-party reviewers, and hospital administration to facilitate necessary hospital care.

Responsibilities

• Performs clinical reviews over the telephone.
• Reviews entire charts to evaluate the appropriateness of admission, continued stay, discharge criteria, and identifies high-risk cases.
• Facilitates discharge planning with the treatment team and coordinates continuum of care for patients with the Social Worker.
• Monitors the effectiveness of patient outcomes.
• Attends treatment team meetings and serves as a liaison and patient advocate between insurance companies and the treatment team.
• Notifies and alerts the Director of Outpatient Services of potential utilization review problems or denials; assists in the preparation and implementation of the appeals process.
• Monitors documentation in clinical records and reports problematic areas to the appropriate supervisor or Director of Outpatient Services.
• Assists admissions with screening patients at the pre-hospitalization level to ensure admission criteria are met.

Requirements

• Bachelor's degree in a related field (required).
• Master’s degree in a related field (preferred).
• One to three years of related experience (required).
• Experience with children and adolescents in a psychiatric facility or rehabilitation program (preferred).
• Good verbal and written communication skills.
• Ability to rotate shifts and programs as necessary.
• Ability to maintain confidentiality of patient information.
• Must consistently exhibit the mental and emotional ability to understand and perform the essential functions of the job.

Physical Requirements

• Must be able to lift and carry up to 50 pounds.
• 80-90% of the time involves standing, walking, kneeling, or reaching while working with residents.
• Requires full range of body motion, including handling and physical restraint of residents.
• Ability to perform CPR and First Aid.

Benefits

• Competitive salary.
• Health insurance available after 30 days.
• Paid Time Off (PTO) starts accruing after 90 days.
• 401(k) with company match, eligible after 30 days.