Utilization Review Coordinator

Futures Recovery Healthcare is a state-licensed, Joint Commission accredited behavioral healthcare provider located in Tequesta, Florida of Palm Beach County. At Futures, we are committed to treating the whole person, not just the behaviors. We have a holistic approach that is patient-centered. Our medical, clinical, resident assistant, admissions, outreach, executive, culinary, alumni, and intake teams all work together to meet a patient where they are and allow them to heal and recover in a safe and nurturing environment, which is essential for whole healing and life-long recovery.

Futures has an immediate need for an experienced Utilization Review Coordinator.

The Utilization Review Coordinator is responsible for establishing and maintaining positive and effective communication with managed care companies in order to maximize necessary length of stay and to ensure quality compliance with medical/clinical staff in regard to patient care standards and treatment. The Utilization Review Coordinator is responsible for scheduling and completing concurrent reviews with Insurance Pre-Certification Companies. The UR Coordinator is a member of the Utilization Review Team, and monitors the documentation accuracy and clinical compliance required.

Requirements

• RN or LPN License in the state of FL, Required
• Previous UR experience.
• Graduate of a Nursing Program, Bachelor’s degree in nursing preferred
• Highly proficient with Microsoft Office Suite, specifically, Microsoft Excel
• 3 years- of clinical experience, preferably in Utilization Review, day treatment, residential and/or hospital setting addressing the substance dependency and/or mental health issues of identified patients.
• Comprehensive understanding of Disease of Addiction and the treatment of individuals with substance dependency and mental health issues
• A comprehensive understanding of the emotional and behavioral effects of addiction
• Exceptional one on one communication skills
• Strong attention to detail as well as strong organization skills
• Excellent verbal and written communication skills
• Ability to use clinical software and other software programs
• Capability to fulfill "on-call" assignment as identified by needs of the business
  
  

Responsibilities

• Provide coaching to team members as needed regarding effective clinical documentation
• Prepares clinical information for each concurrent review directly from the medical record
• Schedules and performs concurrent reviews with Pre-Certification companies for all levels of care
• Maintains the Utilization Review Census with up-to-date authorization information necessary notations
• Maintains each client's Utilization Review chart with current authorization information and relevant notes in the EMR system
• Schedules and performs basic benefit verifications for clients with no authorization policies, lapses in coverage, or COBRA benefits
• Emails CEO/Business Manager regarding any issues or essential information concerning insurance coverage
• Communicates with Business Manager concerning any insurance benefit changes
• Communicates regularly with Medical Team, Clinical Therapists and Case Managers to prepare sufficient information for concurrent reviews
• Provide coaching to team members as needed regarding effective clinical documentation
• Facilitate effective communication between members of the treatment team
• Monitors daily census and identify barriers to discharge
• Assists team members to complete all assigned reviews.
• Maintains accountability for facilitating clinical patient progression through a defined plan of care to achieve optimal outcomes
• A thorough understanding of compliance, policies and procedures regarding medical utilization management functions.
• Participate in daily huddles
• Adheres to all company policies and procedures
• Attends in-service training, when necessary
• Attitude demonstrates a positive approach and commitment reflecting professionalism and ethical standards
• Perform other duties as assigned by the supervisor and/or director
  
  

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