Utilization Review & Care Coordination Specialist

Oceans Healthcare; West Chester (Chester County); On-site; USD 65,000 - 90,000; Full time

Job summary

Oceans Healthcare is seeking an Utilization Review Coordinator to oversee utilization review activities across inpatient, partial hospitalization, and outpatient programs. The role involves concurrent medical record reviews to confirm admission criteria, timely discharge planning, and coordination with third-party payers.

Responsibilities include reporting findings to relevant teams, maintaining payer communications, and supporting performance improvement initiatives.

Qualifications

• Requires strong communication and documentation skills.
• Experience in psychiatric/chemical dependency care preferred.
• Knowledge of reimbursement and utilization review processes is essential.
• Ability to manage high-volume workload with accuracy.

Responsibilities

• Identifies and reports inappropriate use of services to ensure cost-effective, quality care.
• Reviews inpatient, partial hospitalization, and outpatient records for admission appropriateness and discharge planning.
• Communicates with third-party payers and clinical staff to coordinate reimbursement requirements.
• Attends treatment team meetings to gather data from payers and share pertinent information.

Skills

Assertive communication

Writing skills

Discharge planning

Patient advocacy

Data analysis

Time management

CPR certification

De-escalation training

Regulatory knowledge

Minimal supervision

Cultural competency

Education

Associate degree in healthcare

Bachelor’s degree in social services

Job description

Oceans Healthcare is seeking an Utilization Review Coordinator to oversee utilization review activities across inpatient, partial hospitalization, and outpatient programs. The role involves concurrent medical record reviews to confirm admission criteria, timely discharge planning, and coordination with third-party payers.

Responsibilities include reporting findings to relevant teams, maintaining payer communications, and supporting performance improvement initiatives.