Psychiatric Utilization Review Coordinator

A Utilization Review Specialist in a psychiatric hospital plays a crucial role in ensuring that patients receive appropriate care, while also managing resources efficiently. Their main responsibilities involve reviewing patient care plans, treatment protocols, and hospital utilization to ensure they meet established medical standards, insurance requirements, and hospital policies. Here's a typical job description for this position:

Job Title: Utilization Review Specialist

Location: Southern Winds Hospital
Department: Utilization Review / Quality Assurance
Reports To: Director of Utilization Review or Quality Assurance

Job Overview:

The Utilization Review Specialist is responsible for evaluating the appropriateness, necessity, and efficiency of the psychiatric care provided to patients. The role involves reviewing patient treatment plans, documenting services, and ensuring compliance with medical guidelines, insurance policies, and regulatory requirements. This position ensures that the hospital’s resources are utilized effectively while maintaining a high standard of care for patients.

Key Responsibilities:

• Conduct Utilization Reviews: Review patient charts, clinical documentation, and treatment plans to assess the appropriateness of psychiatric care provided, including admissions, length of stay, and discharge planning.
• Ensure Compliance: Ensure adherence to insurance requirements, government regulations, and hospital policies, including verifying the medical necessity of psychiatric treatments.
• Collaborate with Clinical Teams: Work closely with psychiatrists, psychologists, social workers, nurses, and other healthcare professionals to review and evaluate the patient's ongoing treatment plan.
• Communicate with Insurance Providers: Engage with insurance companies to obtain authorization for services and ensure continued coverage for treatment, addressing any discrepancies or issues that arise.
• Prepare Reports and Documentation: Maintain thorough documentation of all utilization review activities, including justifications for admissions, ongoing treatments, and discharges.
• Quality Improvement: Contribute to quality improvement initiatives by identifying trends, suggesting improvements in care, and monitoring compliance with established clinical guidelines.
• Monitor Length of Stay: Track patient length of stay and recommend appropriate discharge planning to avoid unnecessary extended hospitalization.
• Coordinate Care Transitions: Assist in ensuring a smooth transition from inpatient care to outpatient care or community-based resources for continuity of treatment.
• Data Analysis: Review patient outcomes, treatment effectiveness, and resource utilization metrics to ensure the hospital is providing cost-effective, high-quality care.
• Stay Updated on Regulations: Keep up to date with changes in healthcare regulations, insurance policies, and psychiatric treatment standards.

Qualifications:

• Education: Bachelor’s degree in Nursing, Psychology, Social Work, Healthcare Administration, or a related field. A Master’s degree or certification in utilization review (e.g., CPHQ, CCM) may be preferred.
• Experience: Minimum of 2-3 years of experience in utilization review, case management, or clinical coordination within a healthcare setting, preferably in a psychiatric or behavioral health environment.
• Skills:
• Strong knowledge of psychiatric care, including treatment modalities, therapeutic interventions, and behavioral health protocols.
• Familiarity with insurance processes, utilization management software, and medical billing practices.
• Excellent communication and interpersonal skills for working with clinical staff, patients, and insurance providers.
• Ability to analyze clinical data and provide constructive feedback.
• Strong attention to detail and organizational skills.
• Certifications: Certifications in Utilization Review or Case Management (e.g., CPHQ, CCM) are a plus.

Physical Requirements:

• Ability to sit and work at a desk for extended periods.
• Occasionally lift or move materials related to patient care or documentation.

Job Type: Part-time

Pay: $21.00 - $22.00 per hour

Benefits:

• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday
• Weekends as needed

Work Location: In person

Salary : $21 - $22