Utilization Review (UR) / Utilization (UM) Coordinator

UHS•Moultrie, GA

About The Position

The Utilization Review / Utilization Management Coordinator works closely with the other staff of Utilization Review/Management, Intake, Business Office, Medical Records, Clinical Staff, Nursing, and providers to coordinate and communicate patient information to insurance companies for the assignment of benefits. Performs clinical reviews over the telephone and electronically. Utilizes ASAM criteria (DSM-V) to determine appropriateness of admission, continued stay, discharge criteria and identifies high-risk cases. Adheres to accrediting and regulatory agency requirements in maintaining records to ensure compliance. For more than 39 years, Turning Point Care Center has provided a place of healing and hope to adults who suffer from behavioral health disorders and/or substance abuse. We are committed to providing quality behavioral health care through our inpatient and outpatient gender specific programs in Moultrie, GA. Our serene, rural setting gives patients a secure environment where they can build their foundation for lifelong recovery. We believe in creating healthy communities, which start with healthy individuals, linked through sound relationships to their families, friends, neighbors and peers. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.

Requirements

Licensure through state composite board for nursing or counseling/therapy: Minimum RN, LMSW, LAPC, LAMFT
Three (3) years of experience in chart analysis, utilization review, medical/clinical terminology, and acuity of illness
Knowledge and understanding of a variety of insurances including: Traditional Medicare, Medicare Advantage Plans, and Commercial Plans

Nice To Haves

Preferred BSN, MSN, LCSW, LPC, LMFT
Knowledge and experience with chemical dependency programs, mental health programs, situational evaluations, and crisis intervention, preferred.

Responsibilities

coordinate and communicate patient information to insurance companies for the assignment of benefits
Performs clinical reviews over the telephone and electronically.
Utilizes ASAM criteria (DSM-V) to determine appropriateness of admission, continued stay, discharge criteria and identifies high-risk cases.
Adheres to accrediting and regulatory agency requirements in maintaining records to ensure compliance.

Benefits

Medical
Dental
Vision
Life Insurance
Flexible Spending Accounts
Health Savings Accounts
Short and Long Term Disability
401K with match
Employee Stock Purchase Plan
and additional voluntary benefits and discounts.
CEUs required for biannual licensure for Therapists (provided for free without having to use leave to attend)
Rewarding work environment
Growth and Development Opportunities within UHS and its 300+ Subsidiaries
Excellent Medical, Dental, Vision and Prescription Drug Plan
401k plan with company match and discounted stock plan
SoFi Student Loan Refinancing Program