Behavioral Health Utilization Review Coordinator

Universal Health Services; Danville (VA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Home/Work life balance

Medical plan

Dental plan

Vision plan

401(k) plan

Life Insurance

FSA/HSA

Paid time off

Career development

Free meals

Stock purchase

EAP

Job summary

The Hughes Center, part of Universal Health Services, seeks a Utilization Review Coordinator to promote coordinated, effective treatment and manage transitions in residential care for youth with neurodevelopmental disorders.

You will facilitate communication among referral sources, physicians, and payors, maintain approval records, and support admission through discharge processes in a structured, team-based setting.

Qualifications

• A bachelors degree required; masters degrees preferred (Social work, Counseling, Nursing)
• A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
• Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
• Basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders.
• Must know how to gather and analyze data. Must be articulate, assertive, and able to communicate effectively with families, payors, therapists and physicians both verbally and in writing.
• Must demonstrate initiative, tact and good judgement. Must be able to acquire clear understanding of treatment priorities and ability to make sound decisions balancing resident and family needs with available resources.
• Must have basic computer skills.

Responsibilities

• Facilitates communication regarding resident treatment process and needs with referral sources and payor.
• Keeps accurate records of the authorizations for residents in treatment.
• Ensures coordinated effective resident care including admission, continued stays, and discharge requirements.
• Ensures positive relationships with external and internal customers.
• When appropriate, travel to resident’s community representing the facility at FAPT meetings and court hearings.
• Ensures continued availability (recertification) of financial resources throughout the residents’ stay.
• Develop systems to review and respond to concerns expressed by customers. Together with the appropriate Department head, he/she works to resolve issues to satisfaction of the customer and facility.
• Review of clinical patient data with third party reviewers to substantiate the need for continued hospital level of care of ongoing participation in treatment programs.
• Communicate and coordinate third party reviewer’s level of care decisions and expectations to appropriate clinical and administrative staff.
• Assist in preparing Utilization Review Reports as necessary.
• Coordinates and makes Retrospective Appeals to third party payers.
• Meets weekly with Administrator on appropriate issues.
• Other duties as assigned based on the needs of the facility.

Skills

Clinical experience

Patient assessment

Treatment planning

Communication with payors

Data analysis

Medical terminology

Basic computer skills

Education

Bachelor's degree required

Master's preferred (Social Work, Counseling, Nursing)

Tools

Basic computer skills

Job description

The Hughes Center, part of Universal Health Services, seeks a Utilization Review Coordinator to promote coordinated, effective treatment and manage transitions in residential care for youth with neurodevelopmental disorders.

You will facilitate communication among referral sources, physicians, and payors, maintain approval records, and support admission through discharge processes in a structured, team-based setting.