Behavioral Health Utilization Coordinator – Optimize Reimbursement

Dover Behavioral; Dover (DE); On-site; USD 55,000 - 75,000; Full time

Job summary

Dover Behavioral Health System, a 104-bed acute care psychiatric hospital in Dover, Delaware, is seeking a full-time Utilization Management Coordinator. The role focuses on monitoring utilization and optimizing reimbursement, with responsibilities across admission reviews, concurrent reviews, and appeals.

Qualified candidates will hold an MSW or MS in a mental health field or a Registered Nursing License, plus at least one year of case management or hospital experience; preferred: prior UM

Qualifications

• Minimum: MSW or MS in a recognized mental health field or a Registered Nursing License.
• One year experience in case management and/or hospital experience.
• Preferred: one year as a Utilization Management Coordinator at a long-term care facility.

Responsibilities

• Conduct admission reviews with Assessment and Referral Services to ensure up-to-date admissions information.
• Perform concurrent and extended stay reviews at appropriate intervals.
• Prepare and submit appeals to third-party payors, collecting necessary data for hospital and patient support.
• Ensure timely communication of discharge information to insurance companies within 24 hours and maintain logs for the Utilization Review department.

Skills

Case management

Utilization management

Hospital experience

Education

MSW or MS in mental health

Registered Nursing License

Job description

Dover Behavioral Health System, a 104-bed acute care psychiatric hospital in Dover, Delaware, is seeking a full-time Utilization Management Coordinator. The role focuses on monitoring utilization and optimizing reimbursement, with responsibilities across admission reviews, concurrent reviews, and appeals.

Qualified candidates will hold an MSW or MS in a mental health field or a Registered Nursing License, plus at least one year of case management or hospital experience; preferred: prior UM