Utilization Reviewer -Behavioral Health
About The Position
The UR Coordinator is responsible for conducting utilization and quality management activities in accordance with Utilization Review policies and procedures. The Coordinator performs the overall function of providing an ongoing, systematic process for the measurement and assessment of the necessity, appropriateness, and efficiency of facility healthcare services and procedures. Review clinical content of medical records, participate in treatment team meetings, and collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved. Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4. Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems, in addition to other job duties.
Requirements
- Masters Degree or RN Licensed in South Carolina
Nice To Haves
- One to three years of experience in utilization review, case management, or discharge planning
- Three years of experience in a Behavioral Health facility providing multiple levels of care
- Prior experience in Medical Records
Responsibilities
- Conducting utilization and quality management activities
- Measuring and assessing the necessity, appropriateness, and efficiency of facility healthcare services and procedures
- Reviewing clinical content of medical records
- Participating in treatment team meetings
- Collaborating with physicians, therapists, nurses, and pertinent staff to gather data for insurance companies/authorizing entities
- Ensuring initial precertification and continued authorization is achieved
- Inputting pre-certifications and continued stay reviews into Midas
- Following up on unfinished pre-certifications
- Coordinating with the treatment team on necessary follow-ups
- Verifying insurance coverage
- Posting patient payments into MS4
- Gathering clinical criteria
- Communicating clinical criteria
- Entering supporting clinical criteria into computer-based systems
Benefits
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries!
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
