Utilization Management Coordinator/Clinical Therapist

UHS•San Marcos, TX

About The Position

San Marcos Treatment Center, located on 63 acres in the Texas Hill Country, provides residential treatment programming for children and adolescents. The Utilization Management Coordinator facilitates a continuum of service while promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting. The position may also carry a small patient caseload if overflow is needed. The role is responsible for authorization and reimbursement processes, communication with hospital staff and patients, documentation and reporting, and support for data analysis. It also provides direct behavioral healthcare services to children and adolescents with mental illness in residential treatment programs, including assessment, diagnosis, treatment planning, therapy, case management, education, and discharge and aftercare planning.

Requirements

Extensive knowledge of behavioral health systems and utilization management.
Two years of utilization review experience in a hospital or healthcare insurance setting.
Texas LPC, LMHC, LCSW, LCPC, LPCC, or LMSW credential.
Ability to provide effective short-term individual, group, and family therapy services.

Responsibilities

Obtain preauthorization for admissions and continued stays according to third-party guidelines within one business day of admission, unless otherwise required.
Research and obtain necessary insurance contact information and coordinate scheduled meetings between hospital and insurance doctors.
Manage and perform processes for retrospective authorizations and denials or appeals.
Communicate preauthorization outcomes, follow-up instructions, options, and related information to relevant hospital staff and patients in a timely manner.
Respond to calls and emails within one business day unless otherwise required.
Document activity in Billing and UR software and prepare reports for meetings and management review.
Organize and file documents in approved locations for ease of access.
Assist in compiling information for data analysis related to preauthorization and reimbursement.
Assist hospital staff in determining the likelihood that insurance will cover treatment.
Maintain patient confidentiality in accordance with state and federal law.
Participate in hospital information meetings, required in-service education and training, and hospital-wide performance improvement and compliance activities.
Promote and incorporate service excellence standards into job responsibilities and interactions, including service recovery skills in difficult patient discussions.
Respect the rights of patients and staff not to participate in or listen to unproductive conversations expressing frustrations and grievances.
Provide direct behavioral healthcare services to children and adolescents with mental illness in residential treatment programs.
Conduct assessments and diagnosis, develop treatment plans, and provide individual, group, and family therapy.
Perform case management activities, patient and family education, and discharge and aftercare planning.
Carry a small caseload of patients if overflow is needed.