Utilization Management Coordinator

UHS•Jeffersonville, IN

3d•Onsite

About The Position

Wellstone Regional Hospital is a 100-bed acute care facility located in Jeffersonville, Indiana and has been providing quality health care to the residents of Southern Indiana and the Louisville area since 2003. Wellstone specializes in the treatment of Adolescents, Children, Adults, and the CD population. In addition to our in-patient services, we offer out-patient programs as well. Wellstone currently has an opening for a full-time UM Coordinator in the UM Department. The Utilization Review Coordinator is responsible for executing the UR function, which includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients. Oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payers. Assures that good customer service practices are utilized. Maintains denials and appeals logs and reviews the progress of all appeals activity. Over-see compliance of Medicare audits and assure guidelines are being followed.

Requirements

Bachelor Degree in Mental Health/Behavioral Sciences, Master's preferred, or RN in the state of Indiana.
A minimum of three (3) years direct clinical experience in a psychiatric or mental health treatment setting.
Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
None required unless RN.
May be required to work overtime and flexible hours when needed.

Nice To Haves

Master's preferred

Responsibilities

Executing the UR function, which includes the implementation of case management scenarios
Consulting with all services to ensure the provision of an effective treatment plan for all patients
Overseeing the response to requests for services and interfaces with managed care organizations, external reviewers, and other payers
Assuring that good customer service practices are utilized
Maintaining denials and appeals logs and reviews the progress of all appeals activity
Overseeing compliance of Medicare audits and assure guidelines are being followed