Utilization Review Coordinator (UR)

JOIN OUR TEAM AS A UTILIZATION REVIEW COORDINATOR!

THE ESSENTIAL FUNCTIONS OF THE UTILIZATION REVIEW COORDINATOR are as follows but not limited to the duties listed below:

The UR Coordinator is responsible for contacting external case managers/managed care organizations for certification and recertification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. The UR Coordinator is responsible for thoroughly understanding the patient’s treatment through communication with the treatment team. The UR Coordinator advocates for the patient’s access to services during treatment team meetings and through individual physician contact. The UR Coordinator chairs treatment team meetings and continued stay reviews as indicated.

Summary Of Case Management Duties

• Review the treatment plan and advocate for additional services as indicated.
• Promote effective use of resources for patients.
• Ensure that patient rights are upheld.
• Maintain ongoing contact with the attending physician, program manager, nurse manager, and various team members.
• Collaborate with the treatment team regarding continued stay and discharge planning issues.
• Advocate for the patient to be placed in the appropriate level of care and program.
• Interface with program staff to facilitate a smooth transition during transfer or discharge.
• Maintain documentation related to case management activities.
• Assure tracking of insurance reviews and that reviews are completed promptly.
• Maintain statistical reports and prepare documentation of significant findings.
• The essential job functions of this position are not limited to the duties listed above.
  
  

Your Experience Matters What We’re Looking For

Education: Bachelor's or Master's degree from an accredited college or university in social work, mental health, nursing, or related degree preferred;

Experience: A minimum of two (2) years of related experience in a healthcare setting or managed care company, with expertise in patient assessment, treatment planning, utilization management, and/or case management preferred.

Licensure: Must maintain a valid driver's license in the applicable state.

Additional Requirements: Successful completion CPR/ First Aid certification and CPI training to within 90 days of employment before assisting with restraining procedures. May be required to work overtime and flexible hours.

Knowledge, Skills, And Abilities

• Knowledge of case management techniques.
• Knowledge of patient assessment and treatment planning techniques.
• Knowledge of external review organizations (i.e., managed care, Medicare, Medicaid, etc.).
• Excellent leadership and negotiation skills.
• Excellent customer relations skills.
• Excellent organizational and interpersonal communication skills.
• Ability to communicate effectively both verbally and in writing.
• Ability to handle conflicting situations.
• Ability to focus on details in a busy environment.
• Ability to work at a rapid pace in a fast-paced environment.
  
  

Your Care Matters What We Provide For Our Team

• 401(k) matching
• Health insurance
• 100% company-paid life insurance coverage up to 2x your annual salary
• Vision insurance
• Dental insurance
• 100% company-paid long-term disability insurance
• Paid time off
• Paid Holidays
• Cafeteria on site
• Employee engagement events
• Employee assistance program
• Employee recognition program
• Free parking
  
  

What Sets Us Apart

• Career & training development opportunities
• Dynamic and inclusive work environment
• Engaged management team dedicated to your success
• A guiding mission and set of values that serve as both our north star and yours, anchoring our collective purpose and aspirations
  
  

Disclaimer: Benefits are subject to change at the discretion of Ridgeview Institute Smyrna.

Compensation

This is a full-time, non-exempt role; the expected compensation range is $20.00 to $25.00/hour. We’re eager to engage with all qualified candidates, and consideration will be given to experience and skill level. Join us as our UR Coordinator!