Utilization Review Coordinator - Behavioral Health Setting

UHS•Louisville, CO

About The Position

Centennial Peaks Hospital is a 104-bed behavioral health facility in Louisville, Colorado, serving the Denver-metro area for more than 30 years. It provides individualized psychiatric programming for adults, including inpatient services, Electroconvulsive Therapy, Intensive Outpatient Programs, and Partial Hospitalization Programs. The Utilization Review Coordinator applies knowledge of psychiatric diagnoses and clinical indicators to evaluate patient records, determine medical necessity and the appropriateness of level of care, and manage patient benefits. The coordinator serves as a liaison between patients, the hospital, and insurance companies; advocates and negotiates for appropriate length of stay and level of care; and coordinates utilization review activities to support reimbursement. Responsibilities also include leading daily physician treatment team meetings, managing authorizations and outpatient-program reviews, obtaining admission precertification, and working with the business office and admissions department on preliminary benefit verification.

Requirements

Bachelor's-prepared healthcare professional in Counseling, Psychology, or Social Work, or an RN with direct experience.
A minimum of 3–5 years of direct psychiatric patient care experience.
Knowledge of psychiatric care, utilization review, insurance reimbursement procedures, and DSM-V.
Advanced computer skills.
Strong analytical, organizational, verbal, and written skills.

Nice To Haves

Master's degree preferred.
Valid RN license, LCSW, or LPC preferred.

Responsibilities

Evaluate patient medical records to determine illness severity, medical necessity, and appropriate level of care.
Serve as a liaison for patients and the hospital with insurance companies.
Negotiate and advocate for patient length of stay and level of care.
Oversee utilization review activities with other departments to support reimbursement for hospital services.
Lead daily physician treatment team meetings.
Manage authorizations and reviews for outpatient programming.
Obtain precertification at the time of admission.
Work with the business office and admissions department to complete preliminary verification of benefits.
Apply working knowledge of all levels of care offered to appropriately manage patient benefits.