Utilization Review Coordinator

About the role

NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources, and collaborating with multidisciplinary teams.

Responsibilities

• Filing documents as needed
• Initial precertification with payors
• Concurrent clinical review with payors
• Document in the electronic system daily in real time
• Admission audit
• Ensures that CON's/RON's and CMS certifications are completed by provider
• Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer communication
• Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships
• Maintains knowledge of current trends and developments in the field by reading appropriate books, journals, and other literature and attending related seminars or conferences
• Maintains a professional approach with all interactions
• Assures protection and privacy of health information as attained through written, electronic, or oral disclosures
• Cooperates and maintains good rapport with nursing staff, medical staff, and other departments
• Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital policies that apply
• Complies with hospital expectations regarding ethical behavior and standards of conduct
• Complies with federal and hospital requirements in the areas of protected health information and patient information
• Handles reconsiderations, assists with appeals as needed, arranges peer-to-peer level reviews, and reports outcomes to the VP of Care Management and Team
• Provides education to nursing staff, leadership team, and providers regarding documentation
• Actively works with the business office regarding resolution of appeals/denials and retrospective reviews

Qualifications

Education: Bachelor's degree in Behavioral Health, Social Work, Counseling, Nursing, or Psychology required. Master's degree preferred.

Experience: Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.

Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.

Skills

• Must have strong knowledge of medications
• Demonstrate exceptional time management skills
• Demonstrate exceptional data entry skills
• Demonstrate exceptional communication skills
• Must be detail oriented

Benefits

• Competitive pay rates
• Medical, Dental, and Vision Insurance
• NPH 401(k) plan with up to 4% Company match
• Employee Assistance Program (EAP) Programs
• Generous PTO and Time Off Policy
• Special tuition offers through Capella University
• Work/life balance with great professional growth opportunities
• Employee Discounts through LifeMart