UR COORDINATOR PT

UHS

5d

About The Position

River Vista Behavioral Health sits along the bluffs overlooking the San Joaquin River, this brand new, 128-bed facility, will provide high-quality and advanced behavioral health services to residents and visitors in the Central Valley. The new hospital will employ more than 250 people, including clinicians, nurses, mental health technicians, support staff and administration. We are currently seeking a forward thinking and compassionate RN, UTILIZATION MANAGEMENT(UM) COORDINATOR. Facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

Requirements

• Education: Bachelor’s degree in Nursing
• Experience: 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 a minimum of three years utilization management experience within a payer organization.
• License: CA RN license
• Additional Requirements: 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).
• Solid understanding of acute inpatient psychiatric hospital operations, including both mental health and substance abuse treatment.
• Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.
• A strong knowledge of The Joint Commission, HCFA, OSHA regulations, and patient rights standards and all other applicable federal and state laws and regulations governing mental health care facilities.

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 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.
• Facilitates physician reviews with payers as required.

What This Job Offers

• Job Type: Part-time
• Number of Employees: 1,001-5,000 employees