UR COORDINATOR

UHS•Newark, DE

13d

About The Position

Rockford Center is a 138-bed mental health facility located in Newark, DE, providing easy access to a full complement of inpatient and partial behavioral health programs for children and adolescents, adults, and older adults. Rockford is the only child inpatient behavioral health facility in DE, offers an experienced and tenured senior management team, and serves New Castle County and northern Maryland. Website: Psychiatric and Substance Abuse Services | Rockford Center | Newark, DE Position Summary: The PRN Utilization Management (UM) Coordinator plays a critical role in ensuring appropriate and cost-effective care for patients within a behavioral health setting. This position is responsible for conducting utilization reviews, verifying medical necessity, and coordinating with clinical teams and insurance providers to support timely authorization of services. The UM Coordinator works on an as-needed basis, providing coverage during peak times, staff absences, or special projects.

Requirements

Master’s prepared Social Worker or Licensed Registered Nurse (or eligible to receive or renew).
Previous experience in Behavioral Health preferred, but not required.
Current CPR
Strong communication, organizational, and critical thinking skills.
Ability to work independently and adapt to changing priorities in a fast-paced environment.

Nice To Haves

Previous experience in Behavioral Health preferred, but not required.

Responsibilities

Completes pre-certs and concurrent reviews as assigned, on appropriate day and by the specified time.
Completes write-ups on new admissions and step-downs/step-ups as assigned, along with the “Change Level of Care” form when applicable.
Communicates with ARC to gather pre-cert information for new admissions as needed.
Enters authorizations into the MIDAS by the end of each business day.
Participates in daily treatment teams: communicates pertinent payor information, requests, or concerns; gathers information needed for reviews, and facilitates the signing of Medicare forms when applicable.
Takes initiative to independently gather additional information for reviews as needed.
Calls in discharge information to payor by the end of the business day following discharge, or on day of discharge as required by some payors.
Signs patient treatment plans.
Communicates to the Director of UR any unplanned or cancelled discharges, denied days, reasons given for underutilized days, and/or any payor-related problems.
Facilitates physician reviews promptly when a case is denied.
Maintains and updates appropriate records of the UR Department, including UR Worksheets and treatment team notes.