Remote Utilization Management Coordinator

Oceans Healthcare; Lafayette (LA); Remote; USD 55,000 - 75,000; Full time

Job summary

Oceans Healthcare in Lafayette, LA is seeking a Regional Utilization Management Coordinator to oversee utilization review and case management across inpatient facilities, including partial hospitalization and outpatient programs.

The role conducts concurrent reviews of medical records to verify admission criteria, supports discharge planning, and coordinates information between third-party payers and clinical staff, in line with Joint Commission and regulatory standards.

Qualifications

• Bachelor's degree or higher in social services or related field or licensed nurse.
• At least four (4) years utilization management experience in a psychiatric/chemical dependency acute inpatient setting.

Responsibilities

• Identifies and reports under-use, over-use and inefficient use of services to ensure high quality patient care in a cost-effective manner.
• Conducts reviews of inpatient, IOP/partial hospitalization, and outpatient records for admission appropriateness, continued stay, discharge, and timely assessments.
• Coordinates flow of communication between physicians/staff and third-party payers concerning reimbursement requisites.
• Attends treatment team and status meetings to obtain pre-certification and ongoing certification requirements and share pertinent payer data.
• Initiates and completes appeals process for reimbursement denials and notifies inpatients of denials.
• Maintains and updates authorizations and denials in the system; reports monthly findings as needed.

Skills

Assertive communication

Psychiatric care knowledge

MCO/payor understanding

Data analysis

Payer appeals process

Office software

Independent worker

Education

Bachelor's degree

Licensed nurse (optional)

Tools

Outlook

Excel

Word

Job description

Oceans Healthcare in Lafayette, LA is seeking a Regional Utilization Management Coordinator to oversee utilization review and case management across inpatient facilities, including partial hospitalization and outpatient programs.

The role conducts concurrent reviews of medical records to verify admission criteria, supports discharge planning, and coordinates information between third-party payers and clinical staff, in line with Joint Commission and regulatory standards.