Utilization Review Coordinator PRN

Universal Hospital Services Inc.; South Carolina; On-site; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated case manager to provide exceptional support to patients and their families. In this vital role, you will be part of an interdisciplinary team, ensuring the delivery of quality treatment while managing reimbursement processes effectively. Your expertise in psychiatric nursing and strong communication skills will be essential as you conduct reviews, prepare appeals, and maintain records. This position offers a unique opportunity to contribute to patient care and professional growth in a supportive environment, making a meaningful impact on the lives of those you serve.

Qualifications

• Graduate of accredited RN program with current RN license or Masters in Counseling/Social Work.
• Experience in psychiatric nursing preferred; strong communication and organizational skills.

Responsibilities

• Provide quality case management services to patients and families.
• Conduct admission reviews and prepare appeals to third party payors.

Skills

Psychiatric Nursing

Communication Skills

Organizational Skills

Time Management

Interpersonal Skills

Attention to Detail

Education

RN Program Graduate

Masters in Counseling/Social Work

Tools

Computer Skills

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.

1. Maintain appropriate records of the Utilization Review Department.
2. Prepare and submit appeals.
3. Attend mandatory training.
4. Conduct admission reviews and pre-certs.
5. Conduct concurrent and extended stay reviews.
6. Prepare and submit appeals to third party payors.
7. Schedule and conduct 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.
8. Participate in activities which enhance professional growth and development.
9. Demonstrate conduct in keeping with CCBH’s ethical standards.
10. Comply with facility safety, infection control and security program.
11. Support 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.