Utilization Review Coordinator

ODYSSEY BEHAVIORAL GROUP•Franklin, TN

17h

About The Position

Join a passionate and caring team who work collaboratively to support our clients! The Odyssey Eating Disorder Network offers a robust continuum of services for adults and adolescents of all genders in multiple states that specialize in a full array of eating disorder diagnoses and co-occurring conditions. Across our eating disorder network, we meet clients where they are in their recovery and provide the necessary therapeutic techniques to empower sustainable freedom. Our expert clinical teams help clients understand recovery is possible by using individualized treatment plans comprised of a combination of evidence-based treatment modalities. Our goal is to make each client feel safe and close to home by conducting all levels of treatment in comfortable and home-like settings designed to offer a clear step-down process, so clients feel continually supported in their recovery journey. The Utilization Review Coordinator is responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness. The UR Coordinator interacts with outside agencies, third party payer and managed care companies in accordance with contractual agreements, acting as a patient advocate and a representative of the company. Relationships and Contacts Within the organization: Initiates and maintains frequent and close working relationships with the revenue cycle, admissions, business development, facility leadership and clinical team members. Outside the organization: Initiates and maintains frequent and close working relationships with commercial payers, client families and vendors, as needed.

Requirements

Position requires a Bachelor’s degree and 1 year clinical experience in a mental health facility setting.
Position requires incumbent to have a valid driver’s license and vehicle insurance.

Nice To Haves

Experience with eating disorders is strongly preferred.

Responsibilities

Setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Conducts initial pre-certification authorizations, continued stay reviews, care coordination, and discharge planning for appropriateness of treatment.
Assesses the medical necessity of client appropriateness of treatment setting to determine the level of care required.
Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
Inputs and maintains authorization status in the appropriate EMR systems for billing purposes
Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, care throughout the medical management process.
Utilizes the applicable documentation methods needed to communicate effectively with the medical and clinical team(s).
Provides staff with appropriate providers, programs, or community resources.
Collaborates with providers to assess members' needs for early identification and proactive discharge planning.
Facilitates Peer Reviews when needed.
May manage appeals for services denied.
Assists with verifying insurance coverage, when needed.
Participates in and facilitates facility and department meetings, as needed.