UM COORDINATOR IOP

UHS • MADERA, CA

3d

About The Position

Facilitates a continuum of service while promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting. This position will be for our IOP Outpatient department.

Requirements

• Bachelor’s Degree in Nursing, Psychology, or Social Work.
• CA RN license required.
• A minimum of 3-5 years of experience working in an acute inpatient psychiatric setting as a treatment team member and/or utilization management, or years of utilization management experience.
• Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
• Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.
• Solid understanding of acute inpatient psychiatric hospital operations, including both mental health and substance abuse treatment.

Nice To Haves

• Master's preferred.
• License in Social Work, AMFT, Mental Health Counseling preferred.

Responsibilities

• Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on the payer’s criteria.
• Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
• Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.
• Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
• Contributes to monthly utilization data trends using hospital data tools to report for the overall operation.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned/required by this position.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level