Clinical Utilization Review & Care Coordination

Talentify; Danville (VA); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Excellent Medical, Dental, Vision, and

Prescription Drug plans

401(k) Retirement Plan with company 5%

Life Insurance

Flexible Spending or Health Savings

Generous Paid Time Off

Career Development Opportunities

Free meals!

Company stock purchase discount

Employee Assistance Program

Job summary

The Hughes Center, part of Universal Health Services, seeks a Utilization Review (UR) Coordinator to coordinate resident-centered services and promote effective treatment through multi-stakeholder communication and timely transitions in residential care.

The role involves interfacing between referral sources, physician teams, payors, and clinical staff to ensure continuous and quality resident care within a structured psychiatric residential program.

Qualifications

• Bachelor's degree required; master's preferred (Social work, Counseling, Nursing).
• Minimum of three years direct clinical experience in a psychiatric or mental health setting.
• Experience in patient assessment, treatment planning and communication with external review organizations or comparable entities.
• Basic understanding of medical terminology and residential treatment.
• Must gather and analyze data and communicate effectively with families, payors, therapists and physicians.
• Must demonstrate initiative, tact and good judgement; balance resident and family needs with 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.
• Travels to resident’s community for meetings and hearings when appropriate.
• Ensures continued availability of financial resources throughout the residents’ stay.
• Develops systems to review and respond to customer concerns and resolves issues.
• Reviews clinical patient data with third party reviewers to substantiate need for continued hospital level of care.

Skills

Data analysis

Communication skills

Care coordination

Medical terminology

Computer skills

Education

Bachelor's degree

Master's degree preferred

Job description

The Hughes Center, part of Universal Health Services, seeks a Utilization Review (UR) Coordinator to coordinate resident-centered services and promote effective treatment through multi-stakeholder communication and timely transitions in residential care.

The role involves interfacing between referral sources, physician teams, payors, and clinical staff to ensure continuous and quality resident care within a structured psychiatric residential program.