UR Coordinator - Temporary Position

Odyssey-Behavioral-Healthcare; Franklin (TN); On-site; USD 39,000 - 52,000; Full time

Benefits offered by this job

Continuing education & certification

Company matched 401K

Company paid EAP

Job summary

Odyssey Behavioral Healthcare, LLC seeks a Utilization Review Coordinator for a 4-month assignment across the EST and CST time zones. You will monitor utilization, perform pre-certifications, continued stay reviews, and discharge planning to ensure appropriate care and alignment with payer contracts.

Collaborating with revenue cycle, admissions, facility leadership, and clinical teams, you will input authorization statuses in EMR systems and assist with appeals as needed.

Qualifications

• Bachelor’s degree and 1 year clinical experience in a mental health facility.
• Valid driver’s license and vehicle insurance.
• Experience with EMR systems is desirable.

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.
• May manage appeals for services denied.

Skills

Clinical experience

Education

Bachelor’s degree

Job description

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 excellenceMultiple Career Development PathwaysCompany Supported Continuing Education & CertificationMultiple Health Plan Design Options AvailableFlexible Dental & Vision Plan Options100% Company Paid EAP Emotional Well-Being Support100% Company Paid Critical Illness (with health enrollment plan)100% Company Paid Life & ADD401K with Company MatchCompany-Sponsored HSA, FSA, & DSA Tax Savings AccountsGenerous Team Member Referral ProgramParental LeaveHow 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 ContactsWithin 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 purposesConsults 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.What We Are Seeking:Education and ExperiencePosition requires a Bachelor’s degree and 1 year clinical experience in a mental health facility setting.Other RequirementsPosition requires incumbent to have a 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.”