UR Coordinator - Temporary Position

Odyssey Behavioral Group; Franklin (TN); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Career development

CE & certifications

Health plan options

Dental & vision options

Employee Assistance Program

Life & ADD paid by company

401K with company match

HSA, FSA, DSA accounts

Referral program

Parental leave

Job summary

Odyssey Behavioral Healthcare, LLC is seeking an experienced Utilization Review Coordinator in Franklin, TN for a 4-month assignment. You will monitor health care resource use by reviewing admissions and ongoing stays, collaborating with payers, and advocating for patients within contractual guidelines.

This role requires a Bachelor's degree and at least one year of clinical experience in a mental health setting, plus a valid driver's license.

Qualifications

• Bachelor's degree and 1 year clinical mental health experience.
• Valid driver's license and vehicle insurance.
• Experience in a mental health facility setting preferred.

Responsibilities

• Set reviews to ensure compliance with criteria, medical policy, and member eligibility.
• Conducts initial pre-certification authorizations, continued stay reviews, care coordination, and discharge planning for appropriateness of treatment.
• Assesses the medical necessity of client appropriateness of treatment setting to determine the level of care required.
• Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
• Inputs and maintains authorization status in the appropriate EMR systems for billing purposes
• Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, care throughout the medical management process.
• Utilizes the applicable documentation methods needed to communicate effectively with the medical and clinical team(s).
• Provides staff with appropriate providers, programs, or community resources.
• Collaborates with providers to assess members' needs for early identification and proactive discharge planning.
• Facilitates Peer Reviews when needed.
• May manage appeals for services denied.
• Assists with verifying insurance coverage, when needed.
• Participates in and facilitates facility and department meetings, as needed.

Education

Bachelor's degree

Job description

Job Details

Level: Experienced, Job Location: Franklin, TN 37067, Position Type: Full Time, Education Level: 4 Year Degree, Job Category: Health Care, This position is a temporary 4-month assignment. It will be supporting locations in the EST and CST time zones.

What We Offer

• Collaborative environment dedicated to clinical excellence
• Multiple Career Development Pathways
• Company Supported Continuing Education & Certification
• Multiple Health Plan Design Options Available
• Flexible Dental & Vision Plan Options
• 100% Company Paid EAP Emotional Well-Being Support
• 100% Company Paid Critical Illness (with health enrollment plan)
• 100% Company Paid Life & ADD
• 401K with Company Match
• Company-Sponsored HSA, FSA, & DSA Tax Savings Accounts
• Generous Team Member Referral Program
• Parental Leave

How You Will Contribute

The Utilization Review Coordinator is responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness. The UR Coordinator interacts with outside agencies, third party payer and managed care companies in accordance with contractual agreements, acting as a patient advocate and a representative of the company.

Relationships and Contacts

Within the organization: Initiates and maintains frequent and close working relationships with the revenue cycle, admissions, business development, facility leadership and clinical team members.

Outside the organization: Initiates and maintains frequent and close working relationships with commercial payers, client families and vendors, as needed.

Essential Responsibilities

• Setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
• Conducts initial pre-certification authorizations, continued stay reviews, care coordination, and discharge planning for appropriateness of treatment.
• Assesses the medical necessity of client appropriateness of treatment setting to determine the level of care required.
• Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
• Inputs and maintains authorization status in the appropriate EMR systems for billing purposes
• Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, care throughout the medical management process.
• Utilizes the applicable documentation methods needed to communicate effectively with the medical and clinical team(s).
• Provides staff with appropriate providers, programs, or community resources.
• Collaborates with providers to assess members' needs for early identification and proactive discharge planning.
• Facilitates Peer Reviews when needed.
• May manage appeals for services denied.
• Assists with verifying insurance coverage, when needed.
• Participates in and facilitates facility and department meetings, as needed.

Qualifications

Education and Experience

Position requires a Bachelor's degree and 1 year clinical experience in a mental health facility setting.

Other Requirements

Position requires incumbent to have valid driver’s license and vehicle insurance.

Odyssey Behavioral Healthcare, LLC provides equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunity applies to all terms and conditions of employment. Odyssey Behavioral Healthcare, LLC reserves the right to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains "At-Will".