Utilization Review Coordinator — Behavioral Health Discharge Expert

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

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.