Utilization Management Coordinator

UHS•Lancaster, PA

About The Position

Lancaster Behavioral Health Hospital (LBHH) is a 126-bed, inpatient psychiatric hospital and joint venture between Lancaster General Health/Penn Medicine and Universal Health Services. In addition to a general adult unit and dedicated adolescent unit, the facility offers services for treating those with co-occurring disorders on the psychiatric-medical unit, an intensive adult unit to care for those with severe conditions, as well as a women’s trauma unit. The Utilization Management Coordinator is responsible for completing clinical reviews with all payer types to secure authorization for continued treatment, working collectively with hospital operations to ensure timely documentation, functioning as a key member of the multidisciplinary treatment team, ensuring all denials are followed up weekly, and assuring Midas documentation is updated daily and appropriately.

Requirements

Bachelor’s degree in psych related field and/or equivalent combination of education and experience.
1 to 3 years of Utilization Management preferred.

Nice To Haves

Masters preferred.
Registered Nurse or Social Work, Marriage and Family, Mental Health Counseling (i.e. LPC, LMHC, LCSW, LCPC, LPCC) preferred.

Responsibilities

Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer’s criteria.
Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
Ensure that all denials are followed up weekly and documentation is detailed.
Assures that Midas documentation is updated daily and appropriately. That all documentation has enough detail to ensure no issues with payment.