Utilization Review Coordinator-Behavioral Health

Clive Behavioral; Conway (SC); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player in healthcare is seeking a Utilization Review Coordinator to enhance patient care quality. This role involves conducting thorough assessments of healthcare services, ensuring appropriateness of admissions, and managing insurance benefits effectively. Join a dynamic team committed to providing top-notch psychiatric services and rehabilitation, while enjoying a rewarding work environment with competitive compensation and generous benefits. If you're passionate about making a difference in patient care and thrive in a challenging role, this opportunity is perfect for you.

Benefits

Competitive Compensation

Generous Paid Time Off

Medical, Dental, Vision Plans

401(K) with Company Match

Student Loan Refinancing Program

Career Development Opportunities

Qualifications

• Experience in utilization review and quality management in healthcare settings.
• Strong understanding of clinical criteria and case management processes.

Responsibilities

• Conduct utilization and quality management activities per policies.
• Review cases for admission appropriateness and discharge planning.
• Manage insurance benefits through timely review activities.

Skills

Utilization Review

Quality Management

Clinical Criteria Analysis

Case Management

Education

Bachelor's Degree in Healthcare or Related Field

Certification in Utilization Review

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 facility's 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.

If you would like to learn more about the Utilization Review Coordinator position before applying, please contact Shayla Stokely, Director of Human Resources, at [e-mail].