Utilization Review Coordinator - TX

NeuroPsychiatric Hospitals • Clear Lake, TX

1d

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 performs precertification and concurrent clinical reviews with payors, documents activity in the electronic system, supports audits and appeals, and helps ensure required certifications are completed. The position also works with nursing, medical, business office, and other teams to support appropriate documentation, resolve denials, and protect patient 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.
• Conduct admission audits.
• Ensure providers complete CONs/RONs and CMS certifications.
• Maintain professionalism and communicate effectively with internal and external customers, staff, and patients.
• Maintain current knowledge of trends and developments in the field through relevant reading and attendance at seminars or conferences.
• Protect the privacy and security of health information disclosed in written, electronic, or oral form.
• Cooperate and maintain rapport with nursing staff, medical staff, and other departments.
• Comply with applicable federal and state laws, hospital policies, ethical expectations, and requirements for protected health and patient information.
• Handle reconsiderations, assist with appeals, 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, denials, and 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
• Career Level: Mid Level