Utilization Review Coordinator

UHS•Leesburg, VA

58d

About The Position

North Spring Behavioral Healthcare is looking for a fulltime Utilization Review Coordinator to join our compassionate and dynamic team! The Utilization Review Coordinator assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. Interacts and communicates with clinical staff, Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help receive hospital care they need. North Spring Behavioral Healthcare, a subsidiary of Universal Health Services, Inc. (UHS), is a Department of Behavioral Health and Developmental Services (DBHDS)-licensed, and Joint Commission approved 87-bed Psychiatric Residential Treatment Facility, and a 40-bed Inpatient Acute Psychiatric Hospital. North Spring is situated on 42 acres of scenic greenlands in historic Leesburg, VA, approximately 25 miles northwest of Washington, D.C. We provide therapeutic programs for adolescents in a safe and secure environment that encourages growth and self-responsibility. Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected healthcare management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries now have more than 83,000 employees. The UHS business strategy is to build or purchase healthcare properties in rapidly growing markets and create a strong franchise based on exceptional service and effective cost control. Our success comes from a responsive management style and a service philosophy based on integrity, competence and compassion. One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Requirements

Good verbal and written skills, ability to rotate shifts and programs as necessary, ability to maintain confidentiality of patient information. Must consistently exhibit mental and emotional ability to understand and perform the essential functions of the job.
Master’s Degree in Human Services or Registered Nurse License required.
Should have prior experience in a healthcare setting and strong working knowledge of insurance billing and regulations.
Must be able to lift and carry up to 50 pounds; 80-90% of the time the incumbent is standing, walking, kneeling, reaching while working with residents. Requires full range of body motion including handling and physical restraint of residents. Ability to perform CPR and First Aid.

Nice To Haves

Prefer experience with children and adolescents in psychiatric facility or rehabilitation program.

Responsibilities

Performs clinical reviews over the telephone. Reviews that entire chart to evaluate the appropriateness of admission, continued stay, discharge criteria and identifies high-risk cases.
Facilitates discharge planning with treatment team and coordinates continuum of care for the patient with Social Worker. Monitors the effectiveness of patient outcomes.
Attends treatment team meetings and serves as a liaison and patient advocate between insurance companies and the treatment team.
Notifies and alerts Director of Outpatient Services of potential utilization review problems or denials; assists in the preparation and implementation of the appeals process.
Monitors documentation in clinical records and reports problematic areas to appropriate supervisor, Director of Outpatient Services.
Assists admissions with screening patients on the pre-hospitalization level to ensure admission criteria are met.