UR COORDINATOR

Spring Mountain Treatment Center; Las Vegas (NV); On-site; USD 60,000 - 85,000; Full time

Job summary

Spring Mountain Treatment Center is seeking a full‑time UR Coordinator to proactively monitor utilization of services and optimize reimbursement within an acute inpatient environment in Las Vegas.

The role requires a healthcare degree and knowledge of utilization review concepts, with opportunities to lead pre-certifications, quality reviews, and care coordination across departments.

Qualifications

• Bachelor’s degree in nursing, social work, psychology, health information management or other related healthcare field is required; Masters degree preferred.
• Knowledge of health care service delivery systems and third party reimbursement.
• Knowledge of insurances and experience with authorizations required.
• Demonstrates clear and consistent understanding of admission and discharge functions.
• Must be thoroughly conversant with Utilization Review and Quality Assurance principles.

Responsibilities

• Acts as a liaison between managed care organizations and the facility clinical staff.
• Conducts reviews of insurance plans for certification requirements and coordinates reimbursement communications.
• Monitors patient length of stay and informs staff on issues affecting length of stay.
• Gathers data to report utilization, non-certified days, discharges and quality of services.
• Performs quality reviews for medical necessity and services provided.
• Facilitates peer review calls between facility and external organizations.
• Initiates and completes the formal appeal process for denied admissions or continued stay.
• Assists admissions with pre-certifications of care.
• Provides ongoing training for staff on documentation requirements and stay criteria.
• Performs other duties as assigned.

Skills

Communication skills

Healthcare knowledge

Instruction-following

Education

Bachelor's degree in nursing, social work, psychology, health information management or related healthcare field

Masters degree preferred

Job description

Spring Mountain Treatment Center

Spring Mountain Treatment Center is a 110‑bed mental health facility providing acute crisis stabilization services for adults, teens, and children in a secure inpatient setting since 2001. Our individualized treatment includes a structured, therapeutic environment, intensive physician involvement and oversight, and daily group and educational programs. We provide a caring and healthy environment that gives individuals a chance to make positive changes.

Website: https://www.springmountaintreatmentcenter.com

Spring Mountain Treatment Center is currently seeking a dynamic professional to join our team as a full‑time UR Coordinator. The Utilization Review Coordinator proactively monitors utilization of services for patients to optimize reimbursement for the facility.

Job Duties/Responsibilities

• Acts as a liaison between managed care organizations and the facility professional clinical staff.


• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.


• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.


• Gather and develop statistical and narrative information to report on utilization, non‑certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.


• Conduct quality reviews for medical necessity and services provided.


• Facilitate peer review calls between facility and external organizations.


• Initiate and complete the formal appeal process for denied admissions or continued stay.


• Assist the admissions department with pre‑certifications of care.


• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.


• Performs other duties as assigned/required by this position.

Benefits & Rewards Highlights

• Challenging and rewarding work environment


• Competitive Compensation & Generous Paid Time Off (full‑time and part‑time positions)


• Excellent Medical, Dental, Vision and Prescription Drug Plans (full‑time and part‑time positions)


• 401(K) with company match and discounted stock plan


• SoFi Student Loan Refinancing Program


• Tuition savings to continue your nursing education with Chamberlain University


• Career development opportunities within UHS and its 300+ Subsidiaries!


• Pet Insurance


• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

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Qualifications

• Bachelor's degree in nursing, social work, psychology, health information management or other related healthcare field is required; Masters degree preferred.


• Knowledge of health care service delivery systems and third party reimbursement


• Knowledge of insurances and experience with authorizations required.


• Demonstrates clear and consistent understanding of admission and discharge functions.


• Must be thoroughly conversant with the principles of Utilization Review and Quality Assurance.


• Ability to follow both written and verbal instructions


• Understand and honor the established hospital rules, regulations and Policy and Procedures


• Good communication skills, i.e., reading, writing, and speaking


• Ability to follow both written and verbal instructions


• Good leadership qualities which includes self‑control, patience, and empathy


• New hires are required to attend 1 full week of New Employee Orientation on day shift, normally 8:00 am – 4:30 pm Monday through Friday


• Must successfully pass background check (includes criminal history, Child Abuse and Neglect Registry, and ABI/FBI fingerprint check)

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to 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.