IOP Utilization Coordinator - Patient Care & Payer Appeals

Universal Hospital Services Inc.; Madera, Northern (CA, KY); Hybrid; USD 51,000 - 76,000; Full time

Job summary

Universal Hospital Services Inc. in California is seeking an experienced care coordinator for our IOP Outpatient department.

The role focuses on coordinating patient care, daily clinical reviews, quality documentation, and payer communications to promote positive outcomes and optimal reimbursement. The position emphasizes authorization with managed care, CMS compliance, and cross-functional collaboration among social work, nursing, and hospital operations to ensure timely and accurate

Qualifications

• Bachelor's degree in Nursing, Psychology, or Social Work; Master's preferred.
• CA RN licensure required; License in Social Work, AMFT, Mental Health Counseling preferred.
• 3-5 years in acute inpatient psychiatric setting or utilization management.

Responsibilities

• Performs timely, daily clinical reviews with all payer types to secure authorization for continued treatment based on payer criteria.
• Educates and guides on level of care requirements and payer expectations for patient acuity.
• Completes quality and timely appeal/denial letters and supports CMS/audits.
• Coordinates with hospital operations to ensure documentation aligns with patient conditions.
• Contributes to monthly utilization data trends using hospital data tools.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned.

Skills

DSM-V knowledge

Communication skills

Teamwork

Education

Bachelor's degree in Nursing, Psychology, or Social Work

Master's degree preferred

Job description

Universal Hospital Services Inc. in California is seeking an experienced care coordinator for our IOP Outpatient department.

The role focuses on coordinating patient care, daily clinical reviews, quality documentation, and payer communications to promote positive outcomes and optimal reimbursement. The position emphasizes authorization with managed care, CMS compliance, and cross-functional collaboration among social work, nursing, and hospital operations to ensure timely and accurate