Utilization Review Coordinator

Three Rivers Behavioral Health; West Columbia (SC); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

Career development

Diverse programming

Competitive compensation

Medical, Dental, Vision

Employee assistance

401K match

Tuition assistance

Employee referral

Job summary

Three Rivers Behavioral Health in West Columbia, SC is seeking a professional to perform precertification and benefits verification for incoming patients. The role coordinates utilization management with the treatment team and external review organizations to ensure proper approvals and payor communication.

Qualified candidates hold a Masters in a mental health field or RN license, with at least two years of psychiatric chart review and utilization experience.

Qualifications

• Masters in mental health field or RN is required.
• Minimum of two years psychiatric experience in chart analysis and utilization review.
• Knowledge of external review organizations, payor sources, and managed care contracts.
• Ability to communicate clearly with patients, staff, and payors.

Responsibilities

• Precertification and verification of benefits for incoming patients.
• Coordinate utilization management with the treatment team and external review orgs.
• Discuss forms with patients and obtain signatures.
• Complete insurance verification and precertification as well as appeals.

Skills

Psychiatric chart review

Utilization review

Interdisciplinary collaboration

Education

Masters degree in mental health field

Registered Nurse (RN)

Job description

Three Rivers Behavioral Health

Three Rivers Behavioral Health is a 136-bed treatment facility that specializes in quality behavioral health and substance abuse services for adolescents and adults. We offer a full continuum of care through an integrated system of inpatient, partial hospitalization and intensive outpatient programs. Conveniently located between I-20 (Exit 61) and I-26 (Exit 110) in West Columbia, SC, our team of 300+ high quality employees describe working here as " family atmosphere," "supportive leadership," and "life-changing." Progressive professionals in the fields of psychiatry, medicine, nursing, social services, and activity therapy serve hundreds of adults and adolescents each month with the common goal of creating new beginnings. Healthcare professionals have a unique opportunity to affect lives for the better each and every day. Choose Three Rivers and start your life-changing journey today.

Job Duties/Responsibilities

• This position provides precertification and verification of benefits for incoming patients.
• Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations/managed care companies.
• Discuss with patient various forms and obtain signatures from the patients.
• Complete insurance verification from various payors and obtain correct information to complete precertification as well as appeals.

Benefits

• Career development opportunities across UHS and our 300+ locations!
• Diverse programming to expand your experience
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• Employee Assistance Program
• 401(K) with company match and discounted stock plan
• Pet Insurance
• SoFi Student Loan Refinancing Program
• Tuition Assistance
• Employee Referral Program
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

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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Qualifications

Job Requirements

• Education: Masters’ degree in a recognized mental health field or Registered Nurse.
• Experience:
  • Minimum of two years psychiatric experience in chart analysis and in the utilization review field. Excellent oral and written communication skills required in order to communicate in a clear and concise manner with patients, physicians, staff and payors.
  • Knowledge of external review organizations, payor sources, financial planning and contracting (i.e., managed care, Medicare, Medicaid, etc.)
  • Must be able to work in a fast-paced environment with frequent interruptions.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.