Utilization Review Coordinator PRN

ignoredontpost; Greer (SC); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization in South Carolina is seeking a qualified professional for a case management role. The position involves providing quality case management services, maintaining records, conducting reviews, and ensuring compliance with healthcare standards. Ideal candidates will have an RN license or a Master's in Counseling/Social Work and experience in psychiatric nursing.

Qualifications

• Experience in psychiatric nursing preferred.
• Excellent telephone, computer, and communication skills.
• Knowledge of health care service delivery systems.

Responsibilities

• Provide quality case management services to patient populations.
• Conduct admission reviews and pre-certs.
• Prepare and submit appeals to third party payors.

Skills

Communication

Organizational

Interpersonal

Time Management

Policy Interpretation

Education

Graduate of accredited RN program

Masters in Counseling/Social Work

Job description

Responsibilities

To provide quality case management services to all patient populations and their families. To serve as a member of the interdisciplinary team supporting the organization’s treatment program and philosophy and assure the deliverance of quality treatment to patients and their families. To proactively monitor and optimize reimbursement for organization services.

• Maintain appropriate records of the Utilization Review Department. • Prepare and submit appeals. • Attends mandatory training. • Conducts admission reviews and pre-certs. • Conducts concurrent and extended stay reviews. • Prepares and submits appeals to third party payors. • Schedules and conducts treatment team meetings to provide total case management of the patient by reading and discussing written progress notes from charts and communicating any state or local agency legal requirement for case management with the interdisciplinary team. • Participates in activities which enhance professional growth and development. • Demonstrates conduct in keeping with CCBH’s ethical standards. • Complies with facility safety, infection control and security program. • Supports facility service excellence standards.

Qualifications

Graduate of accredited RN program with current RN license, or a Masters in Counseling/Social Work or related field. Experience in psychiatric nursing preferred; high school, preferably college level reading, writing, and math skills. Excellent telephone, computer, and communication skills. Knowledge of health care service delivery systems and third party reimbursement; understanding of admission and discharge function. Familiar with medical terminology, diagnostic terms and treatment modalities; knowledge of medical record keeping; strong interpersonal, organizational, evaluative, and time management skills; policy interpretation skills. Must be familiar with applicable standards and regulations. Flexible; pays attention to detail; able to comprehend psychiatric evaluations, consults, labs, etc.; responsiveness to deadlines; assertiveness, persistence and persuasiveness; able to work with minimal direction or supervision.