Utilization Review Coordinator - Behavioral Health Setting

UHS•Highlands Ranch, CO

1d•Onsite

About The Position

The Utilization Review Coordinator possesses knowledge of psychiatric clinical diagnosis and the ability to articulate those indicators professionally. The UM Coordinator manages medical necessity by evaluating the patient medical records to determine severity of patient’s illness and determining the appropriateness of level of care. Serves as liaison for patients and hospital with insurance companies. Negotiates and advocates for patient length of stay and level of care. Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UM Coordinator leads physician daily treatment team meetings, manages authorizations and reviews for outpatient programming and at time of admission is responsible for obtaining the precertification. The UM coordinator must be able to work with the business office and admissions departments to complete preliminary verification of benefits. The UM Coordinator has a working knowledge of all levels of care offered and appropriately manages patient benefits.

Requirements

Masters prepared healthcare professional (Counseling, Psychology, or Social Work) required or RN with direct experience.
A minimum of 3-5 years direct psychiatric patient care experience.
Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc.
Advanced computer skills necessary.
Strong analytical, organizational, verbal and written skills required.

Nice To Haves

Valid RN license, LCSW, or LPC preferred.

Responsibilities

Manages medical necessity by evaluating patient medical records to determine severity of patient’s illness and appropriateness of level of care.
Serves as liaison for patients and hospital with insurance companies.
Negotiates and advocates for patient length of stay and level of care.
Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital.
Leads physician daily treatment team meetings.
Manages authorizations and reviews for outpatient programming.
Obtains precertification at time of admission.
Works with the business office and admissions departments to complete preliminary verification of benefits.
Has a working knowledge of all levels of care offered and appropriately manages patient benefits.