Lead Utilization Review Coordinator

UHS•West Columbia, SC

48d•Onsite

About The Position

Three Rivers Midlands is seeking a dynamic & talented Full-time Lead Utilization Review Coordinator Three Rivers Midlands is a comprehensive behavioral health facility treating children and adolescents through residential and Rehabilitative Behavioral Health Services (RBH). We treat males and females ages 6-21 for a wide spectrum of psychiatric issues, addictive behaviors, and chemical dependency related illnesses. http://threeriversmidlands.org / The Lead Utilization Review Coordinator Key Responsibilities include: The Lead Utilization Review (UR) Coordinator provides precertification and verification of benefits for incoming residents. Coordinates the utilization management functions of a resident caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations/managed care companies. Completes insurance verification from various payors and obtain correct information to complete precertification as well as appeals. Manage day-to-day activities of Utilization Review department. Demonstrates ability to ensure verification of insurance on all cases. Assist Admissions in education of staff related to precertification/authoriztions. Maintain up to date detail list of Insurance companies, along with how to verify and obtain precertification for each. Maintains 24 hours/day, 7 days/week availability for facility needs based upon AOC Calendar; appoints a designee in the event of non-availability. Other job duties as assigned. This is a Full Time Day Position, 8:30am – 5:00pm. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Requirements

Bachelor's Degree in Health and Human Services or similar field required, but strongly prefer Master's Degree in Health and Human Services Field
Minimum (1) one year in a behavioral health/healthcare setting preferred.
Valid SC Drivers License required
Requires ability to work in a fast-paced environment
Must possess knowledge of therapeutic relationships, therapeutic processes, adolescent growth and development, limit-setting and behavior management

Responsibilities

The Lead Utilization Review (UR) Coordinator provides precertification and verification of benefits for incoming residents.
Coordinates the utilization management functions of a resident caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations/managed care companies.
Completes insurance verification from various payors and obtain correct information to complete precertification as well as appeals.
Manage day-to-day activities of Utilization Review department.
Demonstrates ability to ensure verification of insurance on all cases.
Assist Admissions in education of staff related to precertification/authoriztions.
Maintain up to date detail list of Insurance companies, along with how to verify and obtain precertification for each.
Maintains 24 hours/day, 7 days/week availability for facility needs based upon AOC Calendar; appoints a designee in the event of non-availability.
Other job duties as assigned.