Utilization Review Coordinator (Behavioral Health)-Full Time Days
City/State: Fredericksburg, Virginia
Category: Clinical Professional (Allied Health)
Position Hours: 36Apply
Job Requisition Number: R-2998
Job Department: 2007305 SAF-Care Management
Job Posted Date: May 04, 2021
Start the day excited to make a difference…end the day knowing you did. Come join our team.The Utilization Review Coordinator coordinates care of patients with clinical partners and monitors appropriateness of inpatient and outpatient admissions and continued stay documentation. The incumbent of this position will demonstrate a commitment of quality service to our patients, the community, and our co-workers.
Essential Functions & Responsibilities:
Communicates activity status updates regarding treatment plan with clinical partners.
Applies clinical criteria to monitor appropriateness of admissions and continued stay documents. Relays to associated third party payors and appropriate stakeholders
Refers cases to physician advisor per utilization review procedure as appropriate.
Manages denials related to information provided to/received from payers.
Collaborates with leadership to appropriately address concerns related to delays in discharge, barriers to discharge and trends noted. Identifies barriers to timely discharge and treatment.
Collects delay data for outcome and key performance indicators and documents accordingly.
Ensures key regulatory requirements are met as defined by agencies such as the Centers for Medicare and Medicaid, Virginia Health Quality Center, and the Joint Commission.
Performs other duties as assigned.
- Bachelor’s degree in human services/mental health or other behavioral science discipline required.
- Experience with developmental issues across the life span, with in-depth knowledge of normal and abnormal development of children, adolescents, and adults preferred.
- Minimum two years’ experience in acute care hospital setting, preferred.
- Minimum of two years’ experience in conducting client assessments and evaluations preferred.
- Knowledge and experience in utilization management, discharge planning or case management preferred
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.