Utilization Review Coordinator

Horizon Health Corporation; Danville (VA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Excellent Medical, Dental, Vision, and

401(k) Retirement Plan with company

Life Insurance

Flexible Spending or Health Savings

Generous Paid Time Off

Career Development Opportunities

Free meals

Employee Assistance Program

Job summary

The Hughes Center seeks a talented Utilization Review (UR) Coordinator to join our dedicated care team in a structured psychiatric residential facility for youth. The role focuses on facilitating communication among referral sources, physicians, payors, and the treatment team to promote coordinated, effective care and timely transitions through residential care.

You will maintain authorizations, ensure positive relationships with customers, and support retrospective appeals as needed, while

Qualifications

• Bachelor's degree required; master's preferred in social work, counseling, nursing, or related field.
• Minimum three years direct clinical experience in a psychiatric/mental health setting.
• Experience with patient assessment, treatment planning, and external review coordination.
• Understanding of medical terminology and residential treatment.
• Ability to gather, analyze data and communicate with families, payors, therapists, and physicians.
• Demonstrates initiative, tact, and sound judgment in priority setting and decisions.
• Proficient with basic computer skills.

Responsibilities

• Facilitates communication between referral sources, treatment team, and payors.
• Maintains accurate documentation of authorizations for residents in treatment.
• Ensures coordinated care through admission, stays, and discharge.
• Builds positive relationships with internal and external customers.
• May travel to communities for meetings and hearings when appropriate.
• Assures continued availability of financial resources during residency.
• Reviews concerns with leadership and resolves issues with stakeholders.
• Coordinates third-party review processes and level-of-care expectations.
• Assists in preparing Utilization Review reports as needed.
• Performs Retrospective Appeals to third-party payers.
• Meets weekly with Administrator on relevant issues.
• Performs other duties as assigned.

Skills

Communication skills

Data analysis

Assertiveness

Documentation

Education

Bachelor's degree

Master's degree preferred

Tools

Computer skills

Job description

Responsibilities

The Hughes Center is seeking a talented and dynamic Utilization Review (UR) Coordinator to join our team of dedicated healthcare professionals!

Monday - Friday, Dayshift

The Hughes Center is a highly-structured psychiatric residential treatment facility for youth ages 10 to 22 with neurodevelopmental disorders. The Hughes Center also provides private, community-based educational services. We provide both individualized and holistic care for adolescents and young adults with intellectual and developmental disabilities in a nurturing, family-friendly environment. We utilize a multidisciplinary team approach to provide comprehensive evaluations and evidence-based treatment (and educational) interventions with the intent to increase each youth’s level of functional independence. Our team also works diligently to address or manage medical conditions and challenging behaviors that are often associated with individuals who are diagnosed with neurodevelopmental disorders. We challenge our residents to adapt to and apply learned skills within new environments and situations, and to maintain functional use of these skills when they return to their homes or other community-based settings.

Visit us online: www.thehughescenter.com

Position Summary

Serves as provider for resident-centered services that promote coordinated, effective treatment by facilitating the communication exchange between referral source, physician/treatment team and payor and managing timely transitions through the phases of residential care.

Benefits

https://benefits.uhsguest.com/

• Home/Work Life Balance
• Excellent Medical, Dental, Vision, and Prescription Drug plans
• 401(k) Retirement Plan with company match
• Life Insurance
• Flexible Spending or Health Savings Account
• Generous Paid Time Off
• Career Development Opportunities within UHS and its subsidiaries
• A Challenging and Rewarding Work Environment
• Free meals!
• Company stock purchase discount
• Employee Assistance Program

Key Accountabilities & Duties

• Facilitates communication regarding resident treatment process and needs with referral sources and payor.
• Keeps accurate records of the authorizations for residents in treatment.
• Ensures coordinated effective resident care including admission, continued stays, and discharge requirements.
• Ensures positive relationships with external and internal customers.
• When appropriate, travel to resident’s community representing the facility at FAPT meetings and court hearings.
• Ensures continued availability (recertification) of financial resources throughout the residents’ stay.
• Develop systems to review and respond to concerns expressed by customers. Together with the appropriate Department head, he/she works to resolve issues to satisfaction of the customer and facility.
• Review of clinical patient data with third party reviewers to substantiate the need for continued hospital level of care of ongoing participation in treatment programs.
• Communicate and coordinate third party reviewer’s level of care decisions and expectations to appropriate clinical and administrative staff.
• Assist in preparing Utilization Review Reports as necessary.
• Coordinates and makes Retrospective Appeals to third party payers.
• Meets weekly with Administrator on appropriate issues.
• Other duties as assigned based on the needs of the facility.

Qualifications

• A bachelors degree required; masters degress preferred (Social work, Counseling, Nursing)
• A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
• Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
• Basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders.
• Must know how to gather and analyze data. Must be articulate, assertive, and able to communicate effectively with families, payors, therapists and physicians both verbally and in writing.
• Must demonstrate initiative, tact and good judgement. Must be able to acquire clear understanding of treatment priorities and ability to make sound decisions balancing resident and family needs with available resources.
• Must have basic computer skills.

Licensure

LMHC, LPC, LMSW, LCSW, or RN preferred.

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.

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