UTILIZATION MANAGEMENT COORDINATOR

Springbrook Behavioral Health System • Travelers Rest, SC

2d

About The Position

The UM Coordinator position is responsible for ensuring the provision of quality patient care, effective utilization of available health services, review of medical necessity for continued stay in the hospital (Completing concurrent reviews with insurance companies for continued stay), some case management, analyzing patient records to ensure compliance with government and insurance company reimbursement policies, ensuring compliance with insurance, governmental, and accrediting agency standards, and determining patient review dates according to established diagnostic criteria. Must possess good written and oral communication skills.

Requirements

• Graduate of an accredited School of Nursing, Bachelor in Psychology or Social Work, Master Social Work, or related field
• Currently licensed by the State of S.C. Board of Nursing and/or Board Social Work
• A minimum of two years experience in Utilization Management
• Working knowledge of hospital, JCAHO, CMS and other regulatory bodies
• Knowledge of medical necessity/level of care criteria
• Excellent interpersonal skills to provide a warm and welcoming orientation to new staff and nurses
• Demonstrates understanding of psychiatric illness and its treatment including a sound knowledge regarding psychotropic medications, behavior management, and bio-psychosocial functioning across the life span
• Demonstrates sound judgement, initiative, integrity, dependability, decision making abilities
• Excellent command of the English language (written and orally)

Responsibilities

• Ensuring the provision of quality patient care
• Effective utilization of available health services
• Review of medical necessity for continued stay in the hospital (Completing concurrent reviews with insurance companies for continued stay)
• Some case management
• Analyzing patient records to ensure compliance with government and insurance company reimbursement policies
• Ensuring compliance with insurance, governmental, and accrediting agency standards
• Determining patient review dates according to established diagnostic criteria

What This Job Offers

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