Utilization Review Coordinator-Behavioral Health

UHS•Conway, SC

22h•Onsite

About The Position

The UR Coordinator is responsible for conducting utilization and quality management activities in accordance with Utilization Review policies and procedures. The Coordinator performs the overall function of providing an ongoing, systematic process for the measurement and assessment of the necessity, appropriateness, and efficiency of facility healthcare services and procedures. Assisting in the promotion and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient treatment and length of stay. Reviewing cases for appropriateness of admission, continued stay, and discharge planning. Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review activities. Complies with all Administrative, Clinical, and HR policies and procedures. Maintains an awareness of patient funding sources, discharge planning needs, and available resources in order to facilitate continuity of care. Plans and organizes the functions of the facilities Case Management system to minimize denials of payment. Performs prospective, concurrent and retrospective telephonic reviews for inpatient Mental Health and Dual Diagnosis services. Promotes alternative care programs and researches available options including costs and appropriateness of patient placement in collaboration with discharge planners and patients.

Requirements

One to three years of experience in utilization review, case management, or discharge planning preferred.
Three years of experience in a Behavioral Health facility providing multiple levels of care preferred.
Prior experience in Medical Records a Plus.

Responsibilities

Conducting utilization and quality management activities in accordance with Utilization Review policies and procedures.
Providing an ongoing, systematic process for the measurement and assessment of the necessity, appropriateness, and efficiency of facility healthcare services and procedures.
Assisting in the promotion and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient treatment and length of stay.
Reviewing cases for appropriateness of admission, continued stay, and discharge planning.
Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review activities.
Complying with all Administrative, Clinical, and HR policies and procedures.
Maintaining an awareness of patient funding sources, discharge planning needs, and available resources in order to facilitate continuity of care.
Planning and organizing the functions of the facilities Case Management system to minimize denials of payment.
Performing prospective, concurrent and retrospective telephonic reviews for inpatient Mental Health and Dual Diagnosis services.
Promoting alternative care programs and researching available options including costs and appropriateness of patient placement in collaboration with discharge planners and patients.