UR Utilization Review Coordinator

cmcphoenix; Phoenix (AZ); On-site; USD 47,000 - 50,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Health insurance

Life insurance

Paid time off

Vision insurance

Job summary

College Medical Center Phoenix is seeking an UR Coordinator to facilitate care across the continuum, coordinating resources and discharge planning to help patients access appropriate care.

The role requires utilization management expertise in behavioral health, compliance with HIPAA, and collaboration with a multidisciplinary team. Strong communication and basic computer skills are essential.

Qualifications

• Utilization Management experience in psychiatric settings for 2+ years.
• CCM with 2+ years behavioral health experience or related degree acceptable.
• Two years behavioral health experience with Medicare/Medicaid payor exposure recommended.
• Able to communicate in English (verbal/written).
• Basic computer knowledge.
• Active level one fingerprint clearance card.

Responsibilities

• Validate medical necessity of admission and obtain/verify third-party authorization.
• Apply admission/continued stay criteria for reviews.
• Systematically collect data to determine care needs and treatment.
• Coordinate/discharge planning with multidisciplinary team; advocate for appropriate next level of care.
• Document options in medical records and coordinate next level of care.
• Complete CMS forms and CM notes; pursue reimbursement through appeals.
• Meet Medicare/Medicaid regulatory requirements for inpatient/outpatient behavioral health.
• Coordinate movement to less restrictive care while ensuring continuity of care.
• Perform other duties as required.

Skills

Utilization Management

CCM

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)

Tools

None

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.

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.

Job Type: Full-time

Pay: $34.00 - $36.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person