Utilization Review Coordinator-Behavioral Health

Lighthouse Behavioral Health Hospital; Conway (SC); On-site; USD 55,000 - 75,000; Full time

Job summary

Lighthouse Behavioral Health Hospital, located near Myrtle Beach, SC, seeks an Utilization Review Coordinator to oversee UM/QM activities and ensure efficient, appropriate care. The role evaluates treatment necessity and discharge planning, with emphasis on admission reviews and insurance benefits management.

The UR Coordinator will support high quality care, adhere to policies, and collaborate with discharge planners to optimize patient outcomes in a behavioral health setting.

Qualifications

• RN preferred with SC licensure.
• 1–3 years in utilization review, case management, or discharge planning.
• 3 years in a Behavioral Health facility providing multiple levels of care preferred.
• Prior experience in Medical Records a plus.

Responsibilities

• 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 appropriateness of admission, continued stay, and discharge planning.
• Manage and utilize insurance benefits through telephonic, prospective, concurrent, and retrospective review activities.
• Comply with Administrative, Clinical, and HR policies and procedures.
• Monitor patient funding sources, discharge planning needs, and resources to facilitate continuity of care.
• Organize Case Management system to minimize denials of payment.
• Perform prospective, concurrent and retrospective telephonic reviews for inpatient Mental Health and Dual Diagnosis services.
• Research options including cost and placement appropriateness in collaboration with discharge planners and patients.

Skills

Utilization Review

Case Management

Discharge Planning

Telephonic Reviews

Education

RN Licensure (SC)

Job description

Responsibilities

Utilization Review Coordinator Opportunity!

Lighthouse Behavioral Health Hospital, located near beautiful Myrtle Beach, SC, treats adolescents, adults and senior adults in need of psychiatric services, as well as adults who suffer from a chemical dependency, dual diagnosis, or are in need of rehabilitation. 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 performs the overall function of providing an ongoing, systematic process for the measurement and assessment of the necessity, appropriateness, and efficiency of facility healthcare services and procedures.

• Assisting in the promotion and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient treatment and length of stay.
• Reviewing cases for appropriateness of admission, continued stay, and discharge planning.
• Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review activities.
• Complies with all Administrative, Clinical, and HR policies and procedures.
• Maintains an awareness of patient funding sources, discharge planning needs, and available resources in order to facilitate continuity of care.
• Plans and organizes the functions of the facilities Case Management system to minimize denials of payment.
• Performs prospective, concurrent and retrospective telephonic reviews for inpatient Mental Health and Dual Diagnosis services.
• Promotes alternative care programs and researches available options including costs and appropriateness of patient placement in collaboration with discharge planners and patients.

Benefit Highlights

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications

• Registered Nurses, Preferred. With licensure to practice in SC.
• One to three years of experience in utilization review, case management, or discharge planning preferred.
• Three years of experience in a Behavioral Health facility providing multiple levels of care preferred.
• Prior experience in Medical Records a Plus.

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.