Acute Care Utilization Coordinator

Highland; Charleston, Northern (WV, KY); Hybrid; USD 36,000 - 54,000; Full time

Job summary

Highland Hospital in Charleston, West Virginia is seeking a Utilization Assistant - Acute to support utilization review activities, coordinate benefits verification, and communicate with payers and patients to secure appropriate coverage. The role involves reviewing medical records for level of care, performing pre-certifications, and assisting in appeals.

A High School Diploma is required; a Bachelor’s degree in social work or related health field is preferred, with 1+ year clinical psychiatric

Qualifications

• High School Diploma required; Bachelor’s degree in social work, behavioral or mental health, or related health field preferred.
• One or more years of direct clinical experience in a psychiatric or mental health setting preferred.

Responsibilities

• Assists admissions with pre-certifications of care and benefit verification with managed care organizations.
• Reviews medical records for appropriateness of level of care at admission and intervals.
• Conducts reviews with payers to ensure certification of care and assists in appeals.
• Maintains accurate documentation and files related to utilization management.
• Coordinates information with the business office to resolve payment issues.
• Attends daily treatment team meetings to discuss patient insurance status.

Education

High School Diploma

Bachelor’s Degree in social work, behavioral or mental health, or related health field

Job description

Highland Hospital in Charleston, West Virginia is seeking a Utilization Assistant - Acute to support utilization review activities, coordinate benefits verification, and communicate with payers and patients to secure appropriate coverage. The role involves reviewing medical records for level of care, performing pre-certifications, and assisting in appeals.

A High School Diploma is required; a Bachelor’s degree in social work or related health field is preferred, with 1+ year clinical psychiatric