UR Utilization Review Coordinator

CMC Phoenix; Phoenix (AZ); On-site; USD 60,000 - 85,000; Full time

Job summary

College Medical Center Phoenix is seeking a UR Coordinator to facilitate care across the continuum through effective resource coordination and discharge planning. You will support patients in achieving optimal health and access to care, while ensuring confidentiality per HIPAA regulations.

The role requires Utilization Management and/or behavioral health experience, English communication skills, basic computer knowledge, and an active fingerprint clearance card.

Qualifications

• Utilization Management experience, preferably in a psychiatric setting, for two years, and/or CCM with two years behavioral health experience.
• Two years behavioral health experience and/or previous work in Utilization Management with Medicare/Medicaid payors is highly recommended.
• Able to communicate verbally and in writing in the English language.
• Basic computer knowledge.
• Active level one fingerprint clearance card.

Responsibilities

• Validates the medical necessity of admission and ongoing services of patients and verifies or obtains authorization from third party payors.
• Utilizes needed criteria for admission and continued stay reviews.
• Collects data about the behavioral healthcare status of the patient to determine need and type of care and treatment.
• Identifies levels of treatment and coordinates/assesses continued care and discharge planning, obtaining authorization for next level of treatment when appropriate.
• Documents options in medical records and coordinates with external providers for movement to less restrictive care.
• Ensures compliance with Medicare/Medicaid regulatory requirements for inpatient and outpatient mental health services.
• Completes utilization documentation and CMS forms; pursues reimbursement from payors through appeals.

Skills

Utilization Management experience

Behavioral health experience

English communication

Basic computer knowledge

Fingerprint clearance

Education

Bachelor’s degree in behavioral health

Master’s degree in behavioral health

Certified Case Manager (CCM)

Job description

College Medical Center Phoenix is proud to be the newest addition to College Health Enterprises. We are dedicated to providing the highest quality customer service with warmth, friendliness, and organizational pride. Join a team that values respect, flexibility, a close-knit environment, and the autonomy to utilize your knowledge and experience.

Job Summary

The UR Coordinator is responsible for facilitating care across the continuum through effective resource coordination and discharge planning, assisting patients in achieving optimal health, access to care, and appropriate utilization of resources. This is balanced with the patient’s resources and right to self-determination. The manager must possess knowledge and experience in confidentiality and compliance with HIPAA regulations.

Shift: Monday - Friday

Qualifications:

• Utilization Management experience, preferably in a psychiatric setting for a minimum of two (2) years and/or Certified Case Manager (CCM) with two (2) years behavioral health experience and/or bachelor’s degree in the behavioral health field, and/or a Master’s degree from an accredited University in behavioral health field and/or Certified Case Manager (CCM) and 2 years behavioral health experience is also acceptable.
• Two (2) years behavioral health experience and/or previous work in Utilization Management/Utilization Review working with Medicare and Medicaid payor sources is highly recommended.
• Able to communicate verbally and in writing in the English language.
• Basic computer knowledge
• Active level one fingerprint clearance card.

Job Specific Duties:

• Validates the medical necessity of admission and ongoing services of patients at College Medical Center Phoenix and verifies or obtains authorization from third party payors.
• Utilizes needed criteria for admission and continued stay reviews.
• Continuously collects data about the behavioral healthcare status of the patient in a systematic way to determine the need and type of care and treatment to be provided, and the need for further assessment.
• Identifies various levels of treatment available for the patient and works closely with the multidisciplinary team to coordinate/evaluate continued care and services and also advocate for appropriate discharge planning (including next level of care). Obtains authorization for next level of treatment when appropriate.
• Identifies College Medical Center Phoenix Programs, individual providers and community resources, and documents options in medical record.
• She/he is accountable to problem solve for the care of the patient and to initiate immediate, effective action to maintain patient safety.
• Responsible to meet Medicare/Medicaid regulatory requirements related to the provision of services for inpatient and outpatient mental health treatment.
• Interfaces with external health‑care professionals and providers to coordinate patient movement to a less restrictive level of care and ensures continuity of care.
• Completes utilization documentation as required (CON/RON/Payor forms and CM notes). Ensures reimbursement from third party payors through the appeal process (completes appeal letters).
• Completes CMS form 100% of the time and places on the Medical Record ensuring that physician signs, dates and includes time the CMS form is signed.
• Performs other job duties as required.

Placement in the pay range is based on multiple factors, including but not limited to relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for CMC Phoenix roles, including but not limited to shift differential and other special pay practices. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay that CMC Phoenix, in good faith, believes it might pay for this particular job, based on the circumstances at the time of posting.