Utilization Management Specialist I: Care Coordination

SUN Behavioral Health; Erlanger (KY); On-site; USD 52,000 - 70,000; Full time

Job summary

SUN Behavioral Health is seeking a Case Management Coordinator to oversee coordination of case management strategies from pre-hospitalization through discharge. You will assist with admissions authorization, perform retroactive reviews and appeals, and maintain essential documentation for insurance coverage.

You will coordinate with physicians, nursing, and ancillary departments, participate in performance improvement activities, and ensure compliance with safety and HIPAA standards.

Qualifications

• One year of experience in a behavioral healthcare setting is required.
• CPR and de-escalation certification required.
• Associates or Bachelors degree preferred; substitution allowed.

Responsibilities

• Coordinate patient care from admission through discharge and ensure timely authorizations.
• Process retroactive reviews and appeals; communicate with insurance providers.
• Document in EMR and maintain denial logs; monitor peer reviews and denials.
• Support discharge planning and utilization review; participate in performance improvement.
• Communicate with physicians, nurses, and ancillary staff to coordinate levels of care.

Skills

Documentation

Care coordination

EMR documentation

Medicare/Medicaid knowledge

Denied/appeal management

Communication with physicians and care

Patient/family interaction

Discharge planning

Peer reviews/retroactive reviews

Denial log management

Education

High school diploma or GED

CPR certification

Associates or Bachelors degree preferred

Substitution of experience for education allowed

Tools

EMR system

Job description

SUN Behavioral Health is seeking a Case Management Coordinator to oversee coordination of case management strategies from pre-hospitalization through discharge. You will assist with admissions authorization, perform retroactive reviews and appeals, and maintain essential documentation for insurance coverage.

You will coordinate with physicians, nursing, and ancillary departments, participate in performance improvement activities, and ensure compliance with safety and HIPAA standards.