Utilization Review Coordinator

NeuroPsychiatric Hospitals•Mishawaka, IN

About The Position

Medical Behavioral Hospital is looking for a Utilization Review Coordinator to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams. Specialized Care for the Patients Who Need It Most. NeuroPsychiatric Hospitals (NPH) is dedicated to providing unparalleled service to our patients, team members, physicians, and families. We dare to do things differently, bringing together compassionate care, specialized expertise, and an interdisciplinary approach to meet the unique needs of those we serve. It is this commitment that distinguishes NPH as the healthcare provider of choice. As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute psychiatric and complex medical needs. Our hospitals provide patient-centered care through an interdisciplinary, multi-specialty approach, ensuring our patients receive the specialized support they need when they need it most. With locations in Indiana, Michigan, Texas, Ohio, and Arizona, we are expanding access to our unique model of care across the United States. Join NPH and become part of a team that is daring to do things differently and making a lasting difference in the lives of our patients, families, and communities every day.

Requirements

Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required.
Minimum of 2 years of utilization review experience in a hospital setting required.
Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.
Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills.
Must be detail oriented.

Nice To Haves

Master's degree preferred.
Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.
Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.

Responsibilities

Filing documents as needed.
Initial Precertification with payors.
Concurrent Clinical review with payors.
Document in the electronic system daily in real time.
Admission audit.
Ensures that CON’s/RON’s and CMS certifications are completed by provider.
Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer
Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
Maintains a professional approach with
Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
Cooperate s an d maintains goo d rapport wit h nursin g sta ff , medical staff , and other departments.
Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
Complies with hospital expectations regarding ethical behavior and standards of conduct.
Complies with federal and hospital requirements in the areas of protected health information and patient information.
Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team .
Provides education to nursing staff. ;eadership team, and providers regarding documentation.
Actively works with the business office regarding resolution of appeals/denials and retrospective reviews.