Utilization Review Coordinator-Behavioral Health

Arbour SeniorCare; Conway (SC); On-site; USD 45,000 - 75,000; Full time

Job summary

An established industry player is seeking a dedicated Utilization Review Coordinator to enhance patient care through effective management of healthcare services. This role involves conducting thorough reviews to ensure the appropriateness and efficiency of treatments while collaborating with case managers and patients. The position offers a challenging yet rewarding work environment, competitive compensation, and opportunities for career growth within a respected healthcare organization. If you're passionate about quality care and looking to make a significant impact, this opportunity is perfect for you.

Benefits

Generous Paid Time Off

401(k) with Company Match

Career Development Opportunities

Excellent Medical, Dental, and Vision Plans

SoFi Student Loan Refinance Program

Qualifications

• Experience in utilization review and quality management.
• Strong analytical skills related to patient treatment.

Responsibilities

• Conduct utilization and quality management activities.
• Review cases for admission and discharge planning appropriateness.
• Manage insurance benefits through various reviews.

Skills

Utilization Review

Quality Management

Insurance Benefits Management

Patient Care Coordination

Education

Bachelor's Degree in Healthcare or Related Field

Job description

Responsibilities

Utilization Review Coordinator Opportunity!

Lighthouse Behavioral Health Hospital, located near Myrtle Beach, SC, treats adolescents, adults, and senior adults in need of psychiatric services, as well as adults who suffer from chemical dependency, dual diagnosis, or rehabilitation needs. Lighthouse offers 24-hour admissions, needs assessment, and referral services.

Position Summary:

The UR Coordinator is responsible for conducting utilization and quality management activities in accordance with Utilization Review policies and procedures. The Coordinator provides an ongoing, systematic process for measuring and assessing the necessity, appropriateness, and efficiency of healthcare services and procedures.

• Promote and maintain high-quality care through analysis, review, and evaluation of clinical criteria related to patient treatment and length of stay.
• Review cases for admission, continued stay, and discharge planning appropriateness.
• Manage and utilize insurance benefits effectively via prospective, concurrent, and retrospective reviews.
• Comply with all Administrative, Clinical, and HR policies and procedures.
• Be aware of patient funding sources, discharge planning needs, and available resources to ensure continuity of care.
• Organize the functions of the facility's Case Management system to minimize payment denials.
• Perform telephonic reviews for inpatient Mental Health and Dual Diagnosis services (prospective, concurrent, retrospective).
• Research and promote alternative care options, considering costs and appropriateness, in collaboration with discharge planners and patients.

Benefit Highlights

• Challenging and rewarding work environment
• Competitive compensation and generous paid time off
• Excellent medical, dental, vision, and prescription drug plans
• 401(k) with company match and discounted stock plan
• SoFi Student Loan Refinance Program
• Career development opportunities within UHS and its subsidiaries
• More info at uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, UHS has grown into a Fortune 500 company. Headquartered in King of Prussia, PA, UHS employs 99,000 staff and operates numerous hospitals and facilities across the US, Puerto Rico, and the UK.

To learn more about the Utilization Review Coordinator role, contact Shayla Stokely, HR Director, at [e-mail].