Utilization Review Coordinator - PRN position

Georgetown Behavioral Health Institute; South Carolina; On-site; USD 60,000 - 80,000; Part time

Job summary

Georgetown Behavioral Health Institute is seeking a PRN Utilization Review Coordinator to manage insurance authorizations for inpatient and outpatient services. The role focuses on initial, concurrent, and retrospective reviews to ensure appropriate benefit access.

Ideal candidates have UR or case management experience, nursing background preferred, and knowledge of insurance coverage and billing practices. CPR and crisis management training within 30 days of hire are desirable.

Qualifications

• Bachelor's degree or equivalent in nursing preferred.
• 3-5 years Admitting or Financial Counseling preferred.
• Knowledgeable of insurance coverage and billing practices; UR or case management desirable.

Responsibilities

• Work with insurance companies and managed care systems for initial authorization, concurrent and retrospective review of inpatient, partial, and intensive outpatient admissions and services.
• Obtain authorization for each admitted patient and monitor the authorization process to identify potential problems.
• Support patient access to full range of benefits through the utilization review process.

Skills

Utilization review

Case management

Admitting

Education

Bachelor's degree in nursing

Job description

Our inpatient behavioral health hospital is seeking a PRN Utilization Review Coordinator.

This position is responsible for working with insurance companies and managed care systems for the initial authorization, concurrent and retrospective review of inpatient, partial, and intensive outpatient admissions and services. Previous experience in utilization review or case management desirable.

This position will obtain authorization for each admitted patient. Review and monitor each step of the authorization process to proactively identify potential problems to help patients access the full range of their benefits through the utilization review process.

Requirements

Education and/or Licensure – Bachelor’s degree or equivalent in nursing preferred.

Experience – 3-5 years Admitting or Financial Counseling preferred. Prefer two years clinical experience in a facility with medical terminology and in criteria for acute psychiatric inpatient care. Knowledgeable of insurance coverage and billing practices preferred. Previous experience in utilization review or case management desirable.

Additional Requirements – Must possess or obtain a valid CPR certification and certified in facility approved verbal de-escalation and physical crisis management techniques within 30 days of hire and prior to completion of orientation required.

Benefits

Full-time employees are eligible for medical, dental, vision, company paid disability, 401(k) and a generous amount of paid time off.