Utilization Review Lead — Behavioral Health

Clive Behavioral; Ambler (Montgomery County); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Excellent benefits after 30 days

401(k) plan

Tuition reimbursement

Job summary

The Horsham Clinic in Ambler, PA, seeks a dynamic Utilization Review Coordinator to evaluate medical records, determine severity, and coordinate the appropriate level of care. You will liaise with patients, the hospital, and insurance companies to advocate for length of stay and reimbursement.

Ideal candidates have MSW or RN with PA licensure, plus 3+ years in behavioral health, strong written and verbal communication, and experience with coordination across departments.

Qualifications

• Exposure to psychiatric patients who may exhibit violent/ aggressive behavior in a general hospital environment.
• Must be willing to work with kids and adolescents.
• Masters Level Education/ MSW.
• RN License in the state of Pennsylvania.
• Licensure in LSW/ LSCW.
• Demonstrates working knowledge of behavioral mental health, nursing clinical practices, and management.
• Experience in interviewing patients and families to obtain clinical information and acute symptoms.
• Highly developed written and verbal communication skills.
• 3 or more years of experience in behavioral health setting.
• Ability to plan, direct, and monitor others' activities with leadership abilities.

Responsibilities

• Evaluate medical records to determine severity of patient illness and appropriate level of care.
• Serve as liaison for patients and hospital with insurance companies.
• Negotiate and advocate for length of stay and level of care.
• Oversee UR activities with other departments to ensure reimbursement.

Skills

Communication skills

Interviewing patients

Leadership abilities

Nursing knowledge

Education

Masters Level Education/ MSW

RN License in PA

LSW/ LSCW licensure

Tools

Email applications

Word processing

Databases

Job description

The Horsham Clinic in Ambler, PA, seeks a dynamic Utilization Review Coordinator to evaluate medical records, determine severity, and coordinate the appropriate level of care. You will liaise with patients, the hospital, and insurance companies to advocate for length of stay and reimbursement.

Ideal candidates have MSW or RN with PA licensure, plus 3+ years in behavioral health, strong written and verbal communication, and experience with coordination across departments.