Utilization Management Coordinator - Philadelphia

Progressions; Philadelphia (Philadelphia County); On-site; USD 38,572 - 48,216; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Paid Time Off

401K plan with company match

Job summary

Progressions is hiring a full time Utilization Management Coordinator in Philadelphia. This position involves conducting continued stay reviews, ensuring compliance with medical necessity criteria, and collaborating with treatment teams.

The ideal candidate will possess a Master's degree or an accredited nursing qualification and have experience in utilization review. The role offers a supportive environment focused on professional growth and teamwork.

Qualifications

• Client-focused and team-oriented individual with flexibility to manage workload changes.
• Previous utilization review experience preferred.
• Knowledge of ASAM criteria and medical necessity criteria.

Responsibilities

• Conduct continued stay reviews of medical record documentation.
• Coordinate reviews, appeals, and maintain denial logs.
• Educate new staff members about ASAM criteria and documentation needs.

Skills

Interpersonal skills

Communication skills

Problem-solving skills

Compliance focus

Education

Master's Degree or accredited nursing program

Tools

Microsoft Office

Billing systems

Job description

Job Details: Level: Experienced
Job Location: MTC-Philadelphia - Philadelphia, PA 19131
Position Type: Full Time
Education Level: Graduate Degree
Salary Range: $28.00 - $35.00 Hourly
Travel Percentage: Negligible
Job Shift: Day
Job Category: Health Care

Malvern Treatment Centers is currently seeking a full time Utilization Management Coordinator for our location in Philadelphia! This position is a full time, benefit eligible position and reports to our brand new location at 3905 W. Ford Road Philadelphia, PA 19131.

Position Summary

To conduct continued stay reviews of medical record documentation using pre-established criteria and to provide updated progress reports to third party payers in order to receive certification for payment. This individual will perform all utilization reviews for acute psychiatric and residential drug and alcohol clients.

Essential Position Functions

• Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized and authorization numbers.
• Coordinates reviews, appeals and maintains denial logs.
• Performs concurrent continued stay reviews using pre-established criteria. Understands ASAM criteria and communicates this information accurately to insurance carriers.
• Consults with appropriate treatment team members for clarification of documentation as needed.
• Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals. Inputs data accurately for financial purposes.
• Maintains accurate review sheets of all reviews performed.
• Assists supervisor and departments in identifying patterns of mis-utilization.
• Responds to telephone messages quickly, professionally and appropriately.
• Participates in continuing education to reach professional growth objectives, including maintenance of own credentials, certifications and participating in committees. Attendance at case conference for clinical updates.
• Maintains and communicates authorization information to all team members.
• Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required.
• Educates new staff members about ASAM criteria, high-quality documentation and insurance needs.
• Develops relationship and rapport with payers and third party insurance reviewers.

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Paid Time Off
• 401K plan with company match

Qualifications

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. This position requires individuals that are client focused; team oriented; great interpersonal and communication skills; flexible to sudden changes in workload, emergency or staffing; dependable; problem solving skills; focused on compliance and performance quality. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Master's Degree or graduate of an accredited nursing program with licensure in the state of Pennsylvania. Previous utilization review experience preferred. Applicant must have knowledge of ASAM criteria and medical necessity criteria.

Technical/Computer Skills

Microsoft office and billing experience preferred. Requires much independent action and decision making and ability to organize own work. Knowledge of facility systems and organization as they pertain to medical records and organization review. Knowledge of medical terminology, medical record format and content.

Work Environment and Hazards

Risk of exposure to communicable disease. Possible exposure to intoxicated, disruptive, and/or agitated patients. Protected from weather conditions.

Physical Requirements

Sedentary work primarily – lifting 10 lbs. maximum

Equal Employment Opportunity Statement

Malvern Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.