Utilization Review Coordinator

About the role

Medical Behavioral Hospital is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating 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 communications.
• 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 internal and external customers.
• 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.
• Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the 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 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 and demonstrate exceptional time management, data entry, and 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