Utilization Review Coordinator/Outpatient Nurse (RN) - Behavioral Health Setting

Universal Health Services•Highlands Ranch, CO

43d•Onsite

About The Position

Highlands Behavioral Health System is an 86 bed, acute care psychiatric hospital located in Littleton, CO. Highlands features individual units for adolescents, adults, and seniors, and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. The Utilization Review Coordinator possesses knowledge of psychiatric clinical diagnosis and the ability to articulate those indicators professionally. The UM Coordinator manages medical necessity by evaluating the patient medical records to determine severity of patient's illness and determining the appropriateness of level of care. Serves as liaison for patients and hospital with insurance companies. Negotiates and advocates for patient length of stay and level of care. Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UM Coordinator leads physician daily treatment team meetings, manages authorizations and reviews for outpatient programming and at time of admission is responsible for obtaining the precertification. The UM coordinator must be able to work with the business office and admissions departments to complete preliminary verification of benefits. The UM Coordinator has a working knowledge of all levels of care offered and appropriately manages patient benefits. This role will also act as the Outpatient RN and will assist with clinical screening of admissions, collaborating on treatment plans, interfacing with the treatment team, external case managers, and managed care organizations, and assisting the provider with provider visits and medication management as needed.

Requirements

Current license to practice nursing in Colorado (or eligible to receive or renew).
Graduate of an accredited School of Nursing or baccalaureate program.
Clinical experience in psychiatric setting preferred.

Nice To Haves

Clinical experience in psychiatric setting preferred.

Responsibilities

Manages medical necessity by evaluating the patient medical records to determine severity of patient's illness and determining the appropriateness of level of care.
Serves as liaison for patients and hospital with insurance companies.
Negotiates and advocates for patient length of stay and level of care.
Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital.
Leads physician daily treatment team meetings, manages authorizations and reviews for outpatient programming and at time of admission is responsible for obtaining the precertification.
Works with the business office and admissions departments to complete preliminary verification of benefits.
Manages patient benefits.
Assists with clinical screening of admissions, collaborating on treatment plans, interfacing with the treatment team, external case managers, and managed care organizations, and assisting the provider with provider visits and medication management as needed.