Utilization Review Coordinator - TX

Neuropsychiatric Hospitals • Houston, TX

7h

About The Position

Medical Behavioral Hospital of Clear Lake is seeking a Utilization Review Coordinator to coordinate patients’ services across the continuum of care. The role promotes effective utilization, monitors health resources, and collaborates with multidisciplinary teams. The coordinator also supports documentation quality, payer reviews, appeals, and compliance with requirements for patient and health information.

Requirements

• Bachelor’s degree in Behavioral Health, Social Work, Counseling, Nursing, or Psychology.
• At least 2 years of utilization review experience in a hospital setting.
• At least 2 years of case management experience, including discharge planning, in a hospital setting.
• Strong knowledge of medications.
• Exceptional time-management, data-entry, and communication skills.
• Detail-oriented.

Nice To Haves

• Master’s degree.
• Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification.

Responsibilities

• File documents as needed.
• Complete initial precertification with payors.
• Conduct concurrent clinical reviews with payors.
• Document in the electronic system daily and in real time.
• Perform admission audits.
• Ensure providers complete CON’s/RON’s and CMS certifications.
• Demonstrate professionalism with internal and external customers and communicate effectively with staff and patients to establish and maintain productive working relationships.
• Maintain knowledge of current trends and developments in the field by reading relevant literature and attending seminars or conferences.
• Protect the privacy of health information disclosed in written, electronic, or oral form.
• Maintain good rapport and cooperate with nursing staff, medical staff, and other departments.
• Seek guidance and comply with applicable federal and state laws and hospital policies.
• Comply with hospital expectations for ethical behavior and standards of conduct, and with federal and hospital requirements regarding protected health information and patient information.
• Handle reconsiderations, assist with appeals as needed, arrange peer-to-peer reviews, and report outcomes to the VP of Care Management and Team.
• Educate nursing staff, leadership, and providers regarding documentation.
• Work with the business office to resolve appeals and denials and conduct retrospective reviews.

Benefits

• Competitive pay rates.
• Medical, dental, and vision insurance.
• NPH 401(k) plan with up to 4% company match.
• Employee Assistance Program (EAP) programs.
• Generous PTO and time-off policy.
• Special tuition offers through Capella University.
• Work/life balance and professional growth opportunities.
• Employee discounts through LifeMart.

What This Job Offers

• Job Type: Full-time