Utilization Review Coordinator

Foundations For Living; Ohio; On-site; USD 10,000 - 60,000; Full time

Job summary

Join a forward-thinking organization as a Utilization Review Specialist, where your expertise in medical records and patient advocacy will directly impact the lives of youth in treatment. This role is pivotal in ensuring compliance with quality standards and advocating for the necessary care that supports their recovery journey. You will conduct thorough reviews of treatment plans, challenge adverse decisions, and collaborate with medical providers to ensure that residents receive the best possible care. Be part of a mission-driven team dedicated to empowering youth to heal and build a foundation of hope for their futures.

Qualifications

• Bachelor's degree in a related field required.
• Strong knowledge of medical records review processes essential.

Responsibilities

• Conduct reviews of medical records for residents undergoing treatment.
• Advocate for necessary treatment with medical providers.

Skills

Attention to detail

Medical records review

Effective communication

Advocacy for treatment

Analytical skills

Compassionate approach

Education

Bachelor's degree in healthcare administration

Bachelor's degree in social work

Bachelor's degree in psychology

Job description

Responsibilities

Are you passionate about maintaining the highest standards of patient care quality? We're seeking a dedicated Utilization Review Specialist (URS) to join our team and ensure that the services provided to our facility's residents are in full compliance with established quality standards. If you have a keen eye for detail, a strong understanding of medical records review, and a commitment to advocating for proper treatment, we want to hear from you.

Responsibilities:

• Conduct thorough reviews of medical records for residents undergoing treatment for Alcohol or Other Drugs (AoD) and/or emotional/mental health conditions.
• Verify that treatment utilization aligns with federal, state, and county regulations, ensuring the utmost compliance.
• Assess the ongoing treatment plans to guarantee their appropriateness and effectiveness.
• Take proactive measures to challenge and appeal adverse decisions on behalf of residents.
• Advocate for necessary and required treatment with medical providers, serving as a voice for our residents.
• Consistently follow facility policies and procedures to uphold the highest standards of care.

Qualifications:

• Bachelor's degree in a related field (e.g., healthcare administration, social work, psychology).
• Strong knowledge of medical records review processes and utilization standards.
• Familiarity with federal, state, and county regulations pertaining to patient care.
• Excellent attention to detail and the ability to analyze complex information.
• Effective communication skills for advocating on behalf of residents and collaborating with medical providers.
• Compassionate and empathetic approach when dealing with residents and their treatment needs.

About Us:

Foundations for Living is a secure residential treatment facility designed to address the mental health and substance abuse challenges of youth. With 84 beds, including dedicated accommodations for males and females, we provide a supportive environment for individuals seeking a path towards recovery and improved well-being.

Join our team as a Utilization Review Specialist and make a meaningful impact on the lives of our residents. Your dedication will contribute to their journey to wellness and healing. Apply now to be part of our mission to provide exceptional care and advocacy.

Our mission is to provide an environment of safety where youth feel empowered to heal the wounds of the past and build a foundation of hope for the future.

POSITION SUMMARY

The Utilization Review Specialist (URS) ensures that services provided to facility residents comply with patient care quality standards. Under general supervision, the URS reviews medical records of residents under treatment for AoD and/or emotional or mental illness to ensure proper utilization of treatment in relation to federal, state and county regulations and assesses continuing treatment plans. Appeals adverse decisions on the behalf of the resident and advocates on their behalf for required treatment with medical providers. The Utilization Review Specialist actively and routinely follows facility policies and procedures.