PRN Utilization Management Coordinator

UHS•Dover, DE

About The Position

Dover Behavioral Health System is a 104-bed, acute care psychiatric hospital located in the beautiful Dover, Delaware area. Dover Behavioral Health System features individual units for adolescents and adults and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average, over 10,000 patients receive care from our compassionate health care team each year at Dover Behavioral Health System. This opportunity offers working at a hospital known for its outstanding patient satisfaction, including ranking 6th for highest patient satisfaction in 2020 compared to over 200+ psychiatric hospitals. We attribute this success to our talented and dedicated staff. We are the best at what we do! Dover Behavioral Health system is seeking qualified candidates for our Per Diem Utilization Management Coordinator position. In this role, you will proactively monitor utilization of continuum services and optimize reimbursement.

Requirements

MSW or MS in a recognized mental health field or a Registered Nursing License
One (1) year experience in case management and/or hospital experience

Nice To Haves

One (1) year experience as a Utilization Management Coordinator at a long-term care facility

Responsibilities

Conduct admission reviews working with Assessment and Referral Services to stay abreast of admissions.
Conduct concurrent and extended stay reviews on appropriate day and/or specified time.
Prepare and submit appeals to third party payors, effectively coordinating collection of all pertinent data to support the hospital and patient’s position.
Call/fax discharge information to insurance companies within 24 hours of discharge to ensure the facility is paid for the hospital stay.
Maintain and update logs of review and maintain other appropriate records of the Utilization Review department.
Communicate pertinent third party payors issues to doctor and treatment team.
Attend daily treatment team meetings to discuss acuity issues, third party payors needs and gather information for reviews.
Work independently in gathering information for reviews from the patient record, taking the initiative to seek information from members of the treatment team.
Understand and communicate insurance information to team members, including benefits and levels of care offered.
Perform internal utilization reviews as indicated.
Identify, document, and report any and all instances of adult or child abuse and neglect to the appropriate parties including a member of management, the police, and state agencies