What are the responsibilities and job description for the Utilization Review Coordinator position at ALITA CARE?
Job Details
Description
This is where you change your story…
At Meadows we understand that new directions to career advancing and improvement can be scary, but we are excited to offer you a possible new rewarding chapter with us! Come join us in transforming lives!
Who are we?
Meadows Behavioral Healthcare is a leader in the behavioral health industry. Meadows Behavioral Healthcare offer a range of specialized programs including residential, outpatient and virtual treatment. We provide care for drug and alcohol addiction, trauma, sexual addiction, behavioral health conditions, and co-occurring disorders. We offer state-of-the-art care including neurofeedback and other services. Our evidence-based approach is rooted in decades of clinical experience, with more than 45 years in the field. Our approach is different and success stories from our patients are the proof.
Who are you?
Are you compassionate, innovative and have a passion to make an impact? Are you looking to get your foot in the door with a company that will believe in your abilities and train you to advance? 80% of our current top-level executive staff are organic internal promotions from within.
We might be a perfect fit for you!
Position Summary:
As the Utilization Review Coordinator you will develop and implement systems for the authorization, concurrent and retrospective review of inpatient admissions and services. May also be involved with writing and facilitating appeals for denied treatment days
Responsibilities:
- Provide professional and thorough communication with external representatives to obtain authorization for admission and continued stay. Monitor each step of the authorization process to proactively identify potential problems and optimize outcome.
- Minimize the number of cases that need to be referred for psychiatric peer/peer review. Interact with patient care staff to assure patient assessment and treatment plan is accurately and consistently reflected in facility documentation.
- Prioritize multiple and various types of case activity; coordinate with UM team to ensure all deadlines are met with highest possible quality of delivery.
- Maintain cumulative documentation regarding actions taken during the UR process.
- Conduct reviews to ensure that services and documentation conform to the facility protocols, and the requirements of third party payer sources.
- Attend treatment staffing and other scheduled meetings to obtain and present information on patient status, care and stay.
- Communicate authorization status, issues or problems to appropriate staff/departments
Payor Management:
- Obtain and maintain authorization for each patient.
- Problem-solve issues relating to stay or service.
- Respond quickly and effectively to requests for information.
- Nurture positive and professional relationships with external (third party payer) sources.
Qualifications
Education and Experience:
- Bachelor/Associates Degree in Nursing preferred or related job experience
- Registered Nursing licensure/certification in good standing (RN) CPR Certification optional.
- Prefer a minimum of two years experience in a psychiatric setting or behavioral health utilization review.
- Knowledge of medical terminology, psychiatric interventions and medications and insurance is essential to this position.
We are a Drug Free Company. All positions are designated as Safety Sensitive positions and in light of our company mission, the Company does not employ medical marijuana cardholders. Following an offer of employment, and prior to reporting to work, all applicants will be required to submit to and pass a substance abuse screen.
Meadows Behavioral Health is an equal opportunity employer committed to diversity and inclusion in the workplace. Qualified candidates will receive consideration without regard to race, color, religion, sex, sexual orientation, age, national origin, disability, protected veteran status or any other factor protected by applicable federal, state or local laws. Meadows Behavioral Health provides reasonable accommodations to individuals with disabilities and if you need reasonable accommodation during any time of the employment process, please reach out.
