Utilization Review Coordinator PRN

Thecarolinacenter; South Carolina; On-site; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare organization in South Carolina is seeking a dedicated professional to provide quality case management services. The role involves working with an interdisciplinary team to ensure optimal treatment delivery and reimbursement processes. Ideal candidates will have an RN license or a relevant Master's degree, along with strong communication and organizational skills. Join us in making a positive impact on patient care and support our commitment to service excellence.

Qualifications

• Graduate of an accredited RN program or Master’s in Counseling/Social Work required.
• Experience in psychiatric nursing preferred.

Responsibilities

• Provide quality case management services to patients and families.
• Conduct admission reviews and pre-certifications.
• Prepare and submit appeals to third-party payors.

Skills

Communication

Organizational Skills

Interpersonal Skills

Education

RN License

Master’s Degree 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.

1. Maintain appropriate records of the Utilization Review Department.
2. Prepare and submit appeals.
3. Attend mandatory training.
4. Conduct admission reviews and pre-certifications.
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 reviewing and discussing written progress notes from charts and communicating any legal requirements from state or local agencies with the interdisciplinary team.
8. Participate in activities that enhance professional growth and development.
9. Demonstrate conduct in keeping with CCBH’s ethical standards.
10. Comply with facility safety, infection control, and security programs.
11. Support facility service excellence standards.

Qualifications

Graduate of an accredited RN program with a current RN license, or a Master’s degree in Counseling/Social Work or a related field. Experience in psychiatric nursing is preferred. Must have high school education, preferably with college-level reading, writing, and math skills. Excellent telephone, computer, and communication skills are required. Knowledge of healthcare service delivery systems and third-party reimbursement, understanding of admission and discharge functions, and familiarity with medical terminology, diagnostic terms, and treatment modalities are essential. Must possess strong interpersonal, organizational, evaluative, and time management skills, along with policy interpretation skills. Be familiar with applicable standards and regulations. The candidate should be flexible, detail-oriented, able to interpret psychiatric evaluations, consults, labs, etc., responsive to deadlines, and demonstrate assertiveness, persistence, and persuasiveness. Ability to work with minimal supervision is necessary.