Utilization Review Coordinator

Mt. Washington Pediatric Hospital; Williamsport (Lycoming County); On-site; USD 42,000 - 46,000; Full time

Job summary

Mt. Washington Pediatric Hospital in Williamsport, PA is seeking an Utilization Review Coordinator to optimize clinical/behavioral healthcare resource use in substance abuse treatment settings.

This exempt, full-time role coordinates funding with MCO/SCA and DOC while supporting transitions of care and discharge planning. The position requires a 4-year degree (or equivalent) in a related field and clinical experience in health or human services, with strong documentation and data-tracking

Qualifications

• High school diploma or GED with related experience in a health or human service agency.
• Bachelor’s Degree in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or related field(s) and a minimum of 1 year of clinical experience in a health or human service agency, preferably in a drug and alcohol setting, OR Associate’s Degree in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or related field(s) and a minimum of 2 years of clinical experience in a health or human service agency, preferably in a drug and alcohol setting.

Responsibilities

• Facilitates communications between facility intake, billing, and clinical department as related to obtaining and maintaining client funding for clinical services.
• Prepares and facilitates client pre-certification enrollments, continued stay, transition of care, and discharge reviews in a timely manner.
• Maintains case files in prescribed manner.
• Completes admission, continued stay and discharge ASAMs for residents admitted to the facility during work hours.
• Acts as the point of contact with MCO and SCA agencies on matters related to obtaining funding and continuation of funding for clients.
• Assists counseling staff with identifying client discharge options to include continuing care placement, outpatient services, and other community-based services.
• Updates and maintains an on-going database of referral agencies and discharge referral sources and the appropriate contacts within those agencies.
• Acts as the facility liaison in resolving any funding issues that may arise with the MCO/SCA or DOC and maintain detailed records of any communications between the facility and funding agency (e.g. documents when, where and to whom ASAM forms are sent, records receipt of funding authorizations, etc.
• Coordinates data entry in the WITS and funder-specific systems.
• Complies with all HIPAA and confidentiality requirements.
• Performs other duties as assigned.

Education

Bachelor’s Degree in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or related field(s)

Associate’s Degree in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or related field(s) and 2 years of clinical experience

Job description

• Location 800 W 4th St,Williamsport, PA, 17701,United States
• Base Pay $42,000.00 - $46,000.00 / Year
• Industry Human Service, Medical Authorizations, Substance Abuse
• Relocation Expense Covered No
• Employee Type Exempt
• Required Degree 4 Year Degree
• Manage Others No

Description

The Utilization Review Coordinator performs a variety of duties to ensure the best possible utilization of clinical/behavioral healthcare resources related to the delivery of substance use disorder treatment.

Essential Duties and Responsibilities

• Facilitates communications between facility intake, billing, and clinical department as related to obtaining and maintaining client funding for clinical services.
• Prepares and facilitates client pre-certification enrollments, continued stay, transition of care, and discharge reviews in a timely manner.
• Maintains case files in prescribed manner.
• Completes admission, continued stay and discharge ASAMs for residents admitted to the facility during work hours.
• Acts as the point of contact with MCO and SCA agencies on matters related to obtaining funding and continuation of funding for clients.
• Assists counseling staff with identifying client discharge options to include continuing care placement, outpatient services, and other community-based services.
• Updates and maintains an on-going database of referral agencies and discharge referral sources and the appropriate contacts within those agencies.
• Acts as the facility liaison in resolving any funding issues that may arise with the MCO/SCA or DOC and maintain detailed records of any communications between the facility and funding agency (e.g. documents when, where and to whom ASAM forms are sent, records receipt of funding authorizations, etc.
• Coordinates data entry in the WITS and funder-specific systems.
• Complies with all H.I.PA.A. and confidentiality requirements.
• Performs other duties as assigned.
  

Requirements

Education and/or Experience

A high school diploma or GED equivalent with related experience in ahealth or human service agency, preferably in a drug and alcohol setting.

Bachelor’s Degree in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or related field(s) and a minimum of 1 year of clinical experience in a health or human service agency, preferably in a drug and alcohol setting, OR Associate’s Degree in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or related field(s) and a minimum of 2 years of clinical experience in a health or human service agency, preferably in a drug and alcohol setting. An equivalent combination of education, training, and experience may be considered.

Contact information

• Name Amber Biddle