UR Utilization Review Coordinator

College Medical Center Phoenix; Phoenix (AZ); On-site; USD 52,000 - 78,000; 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, assisting patients in achieving optimal health and access to care. The role requires HIPAA knowledge and confidentiality, plus two years in behavioral health and.Utilization Management experience.

The position notes shift: Monday - Friday, with emphasis on coordinating care with Medicare/Medicaid payors and ensuring regulatory

Qualifications

• Experience in Utilization Management in a behavioral health setting is preferred.
• Two years of behavioral health experience with Medicare/Medicaid payor exposure is highly recommended.
• Ability to communicate effectively in English, both written and spoken.
• Basic computer skills are required.

Responsibilities

• Validates medical necessity of admission and ongoing services and obtains third-party authorizations.
• Uses criteria for admission and continuation of stay reviews.
• Collects behavioral health data to determine care needs and appropriate treatment.
• Coordinates discharge planning and next level of care with the care team.
• Ensures CMS and regulatory documentation is completed accurately.

Skills

Utilization Management experience

Behavioral health experience

Verbal and written English proficiency

Basic computer knowledge

HIPAA compliance awareness

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.

Notice We are aware of a scam whereby imposters are posing as Recruiters from College Medical Center Phoenix, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At College Medical Center and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at College Medical Center Phoenix and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. You will receive emails from the domain cmcphoenix.com. If you suspect a fraudulent job posting or job-related email mentioning College Medical Center Phoenix or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate College Medical Center Phoenix subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.