UR COORDINATOR

UHS • Las Vegas, NV

11h • Onsite

About The Position

Spring Mountain Treatment Center is a 110-bed mental health facility providing acute crisis stabilization services for adults, teens, and children in a secure inpatient setting since 2001. Our individualized treatment includes a structured, therapeutic environment, intensive physician involvement and oversight, and daily group and educational programs. We provide a caring and healthy environment that gives individuals a chance to make positive changes. Spring Mountain Treatment Center is currently seeking a dynamic professional to join our team as a full-time UR Coordinator. The Utilization Review Coordinator proactively monitors utilization of services for patients to optimize reimbursement for the facility.

Requirements

• Bachelor's degree in nursing, social work, psychology, health information management or other related healthcare field is required, Masters degree preferred.
• Knowledge of health care service delivery systems and third party reimbursement
• Knowledge of insurances and experience with authorizations required.
• Demonstrates clear and consistent understanding of admission and discharge functions.
• Must be thoroughly conversant with the principles of Utilization Review and Quality Assurance.
• Ability to follow both written and verbal instructions
• Understand and honor the established hospital rules, regulations and Policy and Procedures
• Good communication skills, i.e., reading, writing, and speaking
• Ability to follow both written and verbal instructions
• Good leadership qualities which includes self-control, patience, and empathy
• New hires are required to attend 1 full week of New Employee Orientation on day shift, normally 8:00 am – 4:30 pm Monday through Friday
• Must successfully pass background check (includes criminal history, Child Abuse and Neglect Registry, and ABI/FBI fingerprint check)

Responsibilities

• Acts as a liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
• Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
• Performs other duties as assigned/required by this position.

Benefits

• Competitive Compensation
• Generous Paid Time Off for full and part-time positions
• Excellent Medical, Dental, Vision and Prescription Drug Plans for full and part-time positions
• 401(K) with company match
• Career development opportunities within UHS and its subsidiaries!

What This Job Offers

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