Utilization Review Coordinator
About The Position
The UM Coordinator is responsible for contacting external case managers/managed care organizations for certification and recertification of insurance benefits throughout the patient’s stay, and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. The UM Coordinator is responsible for having a thorough understanding of the patient’s treatment through communication with the treatment team. The UM Coordinator advocates for the patient’s access to services during treatment team meetings and through individual physician contact. The UM Coordinator chairs treatment team meetings and continued stay reviews as indicated. Case Management/Utilization Management Review the treatment plan and advocate for additional services as indicated. Promote effective use of resources for patients. Ensure that patient rights are upheld. Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the team. Collaborate with the treatment team regarding continued stay and discharge planning issues. Advocate that the patient is placed in the appropriate level of care and program. Interface with program staff to facilitate a smooth transition at the time of transfer or discharge. Maintain documentation related to case management activities. Assure tracking of insurance reviews, and that reviews are completed in a timely manner.
Requirements
- A minimum of two (2) years experience in a healthcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management.
Nice To Haves
- Bachelor’s or Master’s degree from an accredited college or university in social work, mental health, nursing, or related degree.
Responsibilities
- Contact external case managers/managed care organizations for certification and recertification of insurance benefits.
- Assist the treatment team in understanding insurance company requirements for continued stay and discharge planning.
- Maintain a thorough understanding of the patient’s treatment through communication with the treatment team.
- Advocate for the patient’s access to services during treatment team meetings and through individual physician contact.
- Chair treatment team meetings and continued stay reviews as indicated.
- Review the treatment plan and advocate for additional services as indicated.
- Promote effective use of resources for patients.
- Ensure that patient rights are upheld.
- Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the team.
- Collaborate with the treatment team regarding continued stay and discharge planning issues.
- Advocate that the patient is placed in the appropriate level of care and program.
- Interface with program staff to facilitate a smooth transition at the time of transfer or discharge.
- Maintain documentation related to case management activities.
- Assure tracking of insurance reviews, and that reviews are completed in a timely manner.
Benefits
- 401(k) + matching
- Health insurance
- 100% company-paid health insurance up to family coverage
- 100% company-paid life insurance coverage up to 2x your annual salary
- Vision insurance
- Dental insurance
- 100% company-paid long term disability insurance
- Paid time off
- Paid Holidays
- Cafeteria on site
- Employee engagement events
- Employee assistance program
- Employee recognition program
- Free parking
- Career & training development opportunities
- Dynamic and inclusive work environment
- Engaged management team dedicated to your success
- A guiding mission and set of values
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
