Care Coordination & Utilization Review Specialist

The Hughes Center; Danville (VA); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k) with company match

Life Insurance

Flexible Spending or Health Savings (F

Paid Time Off

Career Development

Free meals

Employee Assistance Program

Job summary

The Hughes Center is a highly-structured psychiatric residential treatment facility serving youth ages 10 to 22 with neurodevelopmental disorders. The Utilization Review Coordinator facilitates communication among referral sources, physicians, payors and staff to ensure timely transitions in care.

Qualifications include a bachelor's degree (master's preferred) and 3+ years in a psychiatric setting. Strong data skills and the ability to work with external review entities are required.

Qualifications

• Bachelor's degree required; master's degree preferred (Social work, Counseling, Nursing).
• Minimum of three (3) years direct clinical experience in a psychiatric/mental health setting.
• Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
• Basic understanding of medical terminology, residential treatment, clinical science/pathology and psychiatric disorders.
• Must know how to gather and analyze data and communicate effectively with families, payors, therapists and physicians.

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 meetings and hearings.
• Ensures continued availability of financial resources throughout the residents’ stay.
• Develops systems to review and respond to customer concerns and works with department heads to resolve issues.
• Reviews clinical patient data with third party reviewers to substantiate the need for continued hospital level of care.
• Coordinates and communicates third party reviewer’s level of care decisions to staff.
• Assists in preparing Utilization Review Reports as necessary.
• Coordinates Retrospective Appeals to third party payers.
• Meets weekly with Administrator on appropriate issues.
• Other duties as assigned.

Skills

Communication with families/payors

Data gathering & analysis

Initiative & judgment

Effective written/verbal communication

Computer literacy

Education

Bachelor's degree

Master's degree preferred

Job description

The Hughes Center is a highly-structured psychiatric residential treatment facility serving youth ages 10 to 22 with neurodevelopmental disorders. The Utilization Review Coordinator facilitates communication among referral sources, physicians, payors and staff to ensure timely transitions in care.

Qualifications include a bachelor's degree (master's preferred) and 3+ years in a psychiatric setting. Strong data skills and the ability to work with external review entities are required.