Mental Health Utilization Review Specialist

Universal Hospital Services Inc.; Westwood (GA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Referral Bonus Program

Challenging and rewarding work环境

Competitive Compensation & Generous PT

Excellent Medical, Dental, Vision and

Job summary

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Coordinator to join our case management team in Augusta, GA. The UR Coordinator will integrate clinical content with a focus on patient care, ensuring high-quality and cost-effective treatment in line with UHS policies and regulatory requirements.

The role involves coordinating pre-certification and continued stay reviews, collaborating with physicians and staff, and ensuring accurate data entry into the appropriate

Qualifications

• Master level education in social science field (social work, counseling, sociology, psychology).
• Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC)
• Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review
• Nurses with a current GA or Multistate license encouraged to apply. (LPN, RN)

Responsibilities

• Review clinical content of medical records, participate in treatment team meetings, and collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved.
• Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4.
• Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems, in addition to other job duties.

Skills

Mental health experience

Clinical data review

Healthcare documentation

Education

Masters in social science fields

GA license eligibility or licensed

GA nursing license encouraged

Job description

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Coordinator to join our case management team in Augusta, GA. The UR Coordinator will integrate clinical content with a focus on patient care, ensuring high-quality and cost-effective treatment in line with UHS policies and regulatory requirements.

The role involves coordinating pre-certification and continued stay reviews, collaborating with physicians and staff, and ensuring accurate data entry into the appropriate