Utilization Review Coordinator

NeuroPsychiatric Hospitals; Kalamazoo (MI); On-site; USD 60,000 - 80,000; Full time

Job summary

NeuroPsychiatric Hospitals is seeking a Utilization Review Coordinator for its Kalamazoo Behavioral Health Hospital. The role involves coordinating patient services, conducting utilization reviews, and collaborating with multidisciplinary teams. Candidates should possess a Bachelor's degree in a relevant field and have at least 5 years of experience in a hospital setting.

Benefits

Competitive pay rates

Medical, Dental, and Vision Insurance

NPH 401(k) plan with up to 4% Company match

Employee Assistance Program (EAP)

Generous PTO and Time Off Policy

Special tuition offers through Capella University

Work/life balance with great professional growth opportunities

Employee Discounts through LifeMart

Qualifications

• Minimum of 5 years in utilization review and case management in a hospital setting.
• Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.
• BLS and Handle with Care (HWC) certifications obtained during orientation, if applicable.

Responsibilities

• Coordinate patients’ services across the continuum of care.
• Conduct initial precertification and concurrent clinical reviews with payors.
• Maintain knowledge of current trends and developments in the field.

Skills

Knowledge of medications

Time management

Data entry

Communication skills

Attention to detail

Education

Bachelor's degree in Behavioral Health, Social Work, Counseling, Nursing, or Psychology

Master's degree

Job description

About Us

HEALING THE BODY AND MIND

Founded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously unable to, largely due to the patient’s underlying medical issues. Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for both neuropsychiatric and complex medical care issues. This proven approach provides unrivaled quality care for all of our patients. We have multiple locations throughout the United States and are continuing to add locations to ensure better access to our unique model of care.

Overview

Kalamazoo Behavioral Health Hospital is looking for a Utilization Review Coordinator to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources, and collaborating with multidisciplinary teams.

Benefits of joining NPH

• Competitive pay rates
• Medical, Dental, and Vision Insurance
• NPH 401(k) plan with up to 4% Company match
• Employee Assistance Program (EAP)
• Generous PTO and Time Off Policy
• Special tuition offers through Capella University
• Work/life balance with great professional growth opportunities
• Employee Discounts through LifeMart

Responsibilities

• Filing documents as needed.
• Initial Precertification with payors.
• Concurrent Clinical review with payors.
• Document in the electronic system daily in real time.
• Admission audit.
• Ensure that CONs/RONs and CMS certifications are completed by providers.
• Demonstrate professionalism with all internal and external customers, establishing and maintaining productive relationships.
• Communicate effectively with staff and patients.
• Maintain knowledge of current trends and developments in the field by reading relevant literature and attending seminars or conferences.
• Protect and maintain the privacy of health information in compliance with laws and policies.
• Cooperate and maintain good rapport with nursing, medical staff, and other departments.
• Seek guidance and ensure compliance with all applicable laws and hospital policies.
• Adhere to ethical standards and conduct expectations.
• Assist with reconsiderations, appeals, peer-to-peer reviews, and report outcomes to leadership.
• Provide education to nursing staff, leadership, and providers regarding documentation.
• Work with the business office to resolve appeals/denials and conduct retrospective reviews.

Qualifications

Education: Bachelor's degree in Behavioral Health, Social Work, Counseling, Nursing, or Psychology required; Master's degree preferred.

Experience: Minimum of 5 years in utilization review and case management, including discharge planning, in a hospital setting.

Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. BLS and Handle with Care (HWC) certifications obtained during orientation, if applicable.

Skills: Strong knowledge of medications, exceptional time management, data entry, and communication skills. Attention to detail is essential.