Utilization Review (UR) / Utilization (UM) Coordinator
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.
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
- 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
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
