Lead Utilization Review Coordinator
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. 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.
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
Nice To Haves
- Master's Degree in Health and Human Services Field
- Minimum (1) one year in a behavioral health/healthcare setting preferred.
Responsibilities
- 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.
Benefits
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries!
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Hospitals
Number of Employees
5,001-10,000 employees
