Utilization Management Coordinator/Clinical Therapist

San Marcos Treatment Center; San Marcos (TX); Presencial; USD 60.000 - 90.000; Jornada completa

Descripción de la vacante

San Marcos Treatment Center, located on 63 acres in the Texas hill country and known nationwide for programming for children and adolescents in a residential setting, seeks a Utilization Management Coordinator to facilitate a continuum of service, promote positive outcomes, and optimize reimbursement through coordination of patient care, reviews, and reporting.

The role includes managing preauthorizations, UR processes, documentation, and collaboration with hospital staff while maintaining

Formación

• Extensive knowledge of behavioral health systems and Utilization Management required.
• Two years of UR experience in a hospital or healthcare insurance setting required.
• Texas LPC, LMHC, LCSW, LCPC or LPCC or LMSW

Responsabilidades

• Obtain preauthorization for admissions and continued stays within one business day where required.
• Manage retrospective authorizations and denials/appeals processes.
• Timely communication of preauthorization outcomes to hospital staff and patients.
• Document activity in Billing and UR software and prepare reports for meetings.
• Organize and file documents for easy access in approved locations.
• Assist in compiling data for analysis related to preauthorization and reimbursement.
• Assist hospital staff in determining insurance coverage likelihood for treatment.
• Maintain patient confidentiality per state and federal law.
• Participate in in-service education, performance improvement, and compliance activities.
• Promote service excellence and manage difficult patient discussions professionally.
• Provide direct behavioral healthcare services to children/adolescents in residential treatment as needed.

Conocimientos

Utilization Management

Preauthorization

UR Experience

Behavioral Health

Educación

Texas LPC, LMHC, LCSW, LCPC or LPCC or LMSW

Herramientas

Billing software

UR software

Descripción del empleo

Responsibilities

San Marcos Treatment Center located on 63 acres in the Texas hill country known nationwide with programming for children and adolescents in a residential treatment setting is seeking a Utilization Management Coordinator to Facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting. The position will be required to carry a small caseload of patients if overflow is needed.

Qualifications

Utilization Management Coordinator

The specific duties of the Utilization Management Coordinator include but are not limited to:

• Obtaining preauthorization for admissions and continued stays according to third party guidelines within one business day of admission (unless otherwise required), including researching and obtaining any necessary insurance contact information, and coordinating scheduled meetings between hospital and insurance doctors.
• Managing and performing the processes for retrospective authorizations and denials/appeals.
• Timely communicating preauthorization outcomes, follow-up instructions, options, and related information to relevant hospital staff and patients. This includes responding to all calls and emails within one business day unless otherwise required.
• Documenting activity in Billing and UR software, and preparing reports for meetings and management review.
• Organizing and filing documents for ease of access in approved locations.
• Assisting in compiling information for data analysis relating to preauthorization and reimbursement.
• Providing assistance to hospital staff in determining the likelihood of insurances covering treatment.
• Maintaining patient confidentiality in accordance with state and federal law.
• Participating in hospital information meetings, required in-service education and training, and hospital-wide performance improvement and compliance activities.
• Promote and incorporate service excellence standards into job responsibilities and interactions. This includes incorporating service recovery skills into difficult patient discussions, and respecting the rights of patients and staff not to participate in or listen to conversations where frustrations and grievances are expressed in an unproductive manner.
• Responsible and accountable for providing direct behavioral healthcare services to children adolescents with mental illness in residential treatment programs, including assessments, diagnosis, treatment planning, individual, group, and family therapy, case management activities, patient and family education, and discharge and aftercare planning.

Other Skills, Abilities And Requirements

• Extensive knowledge of behavioral health systems and Utilization Management required.
• Two years of UR experience in a hospital or healthcare insurance setting required.
• Texas LPC, LMHC, LCSW, LCPC or LPCC or LMSW
• Ability to provide effective short term individual, group and family therapy services

About Universal Health Services

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.