Utilization Coordinator

Riveredge Hospital, Inc.; Forest Park (OH); On-site; USD 60,000 - 90,000; Full time

Job summary

Riveredge Hospital is seeking an Uptempo Utilization Management Coordinator to oversee and optimize the daily UM operations within the Forest Park community. You will supervise staff, review documentation, and ensure adherence to policy and regulatory standards.

The role involves mentoring UM personnel, coordinating with committees, and contributing to performance improvement initiatives to enhance reimbursement outcomes and care quality.

Qualifications

• Minimum of 2-3 years supervisory experience.
• Thorough understanding of UM data from admission, reviews and appeals using Severity of Illness/Intensity of Service criteria.
• Knowledge of JC, CMS, Illinois Mental Health Code Act, and other regulatory standards.

Responsibilities

• Oversee daily activities of Utilization Management staff: assigning and scheduling, reviewing and approving docs and reports.
• Advise and mentor UM staff; oversee procedures for work processes, forms and billing.
• Assist with hiring, coaching and counseling staff to ensure compliance with internal policies and external agencies.
• Lead Utilization Management Committee meetings and participate in performance improvement teams.

Skills

Supervisory experience

UM data knowledge

Verbal & written communication

Regulatory compliance

Education

Bachelor’s degree

Master’s degree preferred

Job description

Responsibilities

Shape the future of behavioral health care throughout the Forest Park community by joining our extraordinary team at Riveredge Hospital. Bring your compassion, expertise, enthusiasm, and passion for quality to a place that cultivates wellness and inspires hope.

TheUtilization Management Coordinator position oversees the daily activities of the Utilization Management staff including but not limited to assigning and scheduling; reviewing and approving documentation and reports; advising and mentoring UM staff; and overseeing operational procedures involving work processes, forms, and billing. Assists with hiring, coaching, and counseling staff and compliance with internal policies and outside governmental and regulatory agencies. Conducts the Utilization Management Committee meetings, staff meetings, in-services, and participates in performance improvement teams.

Qualifications

• Must have a Bachelor’s degree, Master’s degree preferred.
• Must have an appropriate background in the mental health field to organize and achieve quality performance with a focus on securing reimbursement for the organization.
• Possess an in depth knowledge of funding sources and government reimbursement protocols.
• A minimum of 2-3 years supervisory experience.
• Thoroughly understands the management of UM data obtained from admission, concurrent reviews and appeals utilizing the Severity of Illness/Intensity of Service Criteria.
• Has knowledge of JC, CMS, Illinois Mental Health Code Act, and all other relevant state and federal regulatory standards.
• Possesses strong verbal and written communication skills.