UR Coordinator - Temporary Position

ODYSSEY BEHAVIORAL GROUP•Franklin, TN

9d•Onsite

About The Position

The Utilization Review Coordinator is responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness. The UR Coordinator interacts with outside agencies, third party payers and managed care companies in accordance with contractual agreements, acting as a patient advocate and a representative of the company. Relationships and Contacts Within the organization: Initiates and maintains frequent and close working relationships with the revenue cycle, admissions, business development, facility leadership and clinical team members. Outside the organization: Initiates and maintains frequent and close working relationships with commercial payers, client families and vendors, as needed.

Requirements

Bachelor’s degree
1 year clinical experience in a mental health facility setting
Valid driver’s license
Vehicle insurance

Responsibilities

Setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Conducts initial pre-certification authorizations, continued stay reviews, care coordination, and discharge planning for appropriateness of treatment.
Assesses the medical necessity of client appropriateness of treatment setting to determine the level of care required.
Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
Inputs and maintains authorization status in the appropriate EMR systems for billing purposes
Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, care throughout the medical management process.
Utilizes the applicable documentation methods needed to communicate effectively with the medical and clinical team(s).
Provides staff with appropriate providers, programs, or community resources.
Collaborates with providers to assess members' needs for early identification and proactive discharge planning.
Facilitates Peer Reviews when needed.
May manage appeals for services denied.
Assists with verifying insurance coverage, when needed.
Participates in and facilitates facility and department meetings, as needed.