UM COORDINATOR IOP

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

Responsibilities

Position Summary:

Facilitates a continuum of service while promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

This position will be for our IOP Outpatient department

QUALIFICATIONS

Education: Bachelor's Degree in Nursing, Psychology, or Social Work. Master's preferred.

Licensure: CA RN licenserequired. License in Social Work, AMFT, Mental Health Counseling preferred

Experience: A minimum of 3-5 years of experience working in an acute inpatient psychiatric setting as a treatment team member and/or utilization management, or years of utilization management experience

RN pay ranges- $50-$55

SW pay ranges- $37-$42

Qualifications

1. Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
2. Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers
3. Solid understanding of acute inpatient psychiatric hospital operations, including both mental health and substance abuse treatment.

Essential Job Duties/Responsibilities

1. Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on the payer's criteria.
2. Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
3. Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators
4. Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
5. Contributes to monthly utilization data trends using hospital data tools to report for the overall operation
6. Facilitates physician reviews with payers as required
7. Performs other duties as assigned/required by this position

Equal Employment Opportunity

It is the policy of the facility to provide equal opportunity in employment to all employees and applicants for employment. No person will be discriminated against in employment based on race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state, or local laws.

Americans with Disabilities Act

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.

Service Excellence.

Service excellence is a part of all we do. Our standards include:

• Treat everyone as a guest by making a good first impression, anticipating needs and displaying service recovery skills.
• Demonstrate professionalism and excellence by looking professional, being accountable for actions and delivering excellence in our everyday work.
• Practice teamwork by participating in decision making and process improvement, communicating effectively and focusing on the problem/issue, not the person.