Utilization Review Coordinator

NeuroPsychiatric Hospitals•Huber Heights, OH

About The Position

North Valley Behavioral Hospital, a brand new psychiatric hospital within the NeuroPsychiatric Hospitals network, 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.

Requirements

Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required.
Experience: 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.
Skills: 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.
Licensure: 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.