Utilization Review Coordinator; On-site

Overview

Join Our Team as a Utilization Review Coordinator! North Spring Behavioral Healthcare is looking for a full-time Utilization Review Coordinator (on-site) to join our compassionate and dynamic team.

• Competitive Salary
• Comprehensive Benefits Package:
  • Health insurance – Available after just 30 days.
  • Paid Time Off – Start earning after 90 days.
  • 401(k) with company match – Eligible after 30 days.

The Utilization Review Coordinator assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met and, when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. Interacts and communicates with clinical staff, Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help receive hospital care they need.

• Performs clinical reviews over the telephone and reviews the entire chart 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 the patient with a Social Worker, monitoring 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, Director of Outpatient Services.
• Assists admissions with screening patients at the pre-hospitalization level to ensure admission criteria are met.

• Good verbal and written communication skills, ability to rotate shifts and programs as necessary, and maintain confidentiality of patient information.
• Education:
  
  Master’s Degree in Human Services or Registered Nurse License required.
• Experience:
  
  Prior experience in a healthcare setting and strong working knowledge of insurance billing and regulations; preference for experience with children and adolescents in psychiatric facilities or rehabilitation programs.
• Physical Requirements:
  
  Ability to lift and carry up to 50 pounds; 80-90% of the time standing, walking, kneeling, and reaching while working with residents. Requires full range of body motion and the ability to perform CPR and First Aid.

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.