UR COORDINATOR

About the Role

Spring Mountain Treatment Center is a 110-bed mental health facility providing acute crisis stabilization services for adults, teens, and children in a secure inpatient setting since 2001. Our individualized treatment includes a structured, therapeutic environment, intensive physician involvement and oversight, and daily group and educational programs. We provide a caring and healthy environment that gives individuals a chance to make positive changes.

Responsibilities

• Act as a liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
• Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges, and quality of services, as required by the facility leadership or corporate office.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria, and medical necessity updates.
• Perform other duties as assigned/required by this position.

Requirements

• Bachelor's degree in nursing, social work, psychology, health information management, or other related healthcare field is required; Master's degree preferred.
• Knowledge of health care service delivery systems and third-party reimbursement.
• Knowledge of insurances and experience with authorizations required.
• Demonstrates clear and consistent understanding of admission and discharge functions.
• Must be thoroughly conversant with the principles of Utilization Review and Quality Assurance.
• Ability to follow both written and verbal instructions.
• Understand and honor the established hospital rules, regulations, and Policy and Procedures.
• Good communication skills, i.e., reading, writing, and speaking.
• Good leadership qualities which include self-control, patience, and empathy.
• New hires are required to attend 1 full week of New Employee Orientation on day shift, normally 8:00 am – 4:30 pm Monday through Friday.
• Must successfully pass background check (includes criminal history, Child Abuse and Neglect Registry, and ABI/FBI fingerprint check).

Benefits

• Challenging and rewarding work environment.
• Competitive compensation.
• Generous Paid Time Off for full and part-time positions.
• Excellent Medical, Dental, Vision, and Prescription Drug Plans for full and part-time positions.
• 401(K) with company match.
• Career development opportunities within UHS and its subsidiaries.

Pay

Minimum: $26.45/hour