RN - UR COORD

River Vista Behavioral Health sits along the bluffs overlooking the San Joaquin River, this brand new, 128-bed facility, will provide high-quality and advanced behavioral health services to residents and visitors in the Central Valley. The new hospital will employ more than 250 people, including clinicians, nurses, mental health technicians, support staff and administration.

We are currently seeking a forward thinking and compassionate RN, UTILIZATION MANAGEMENT(UM) COORDINATOR. Facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

QUALIFICATIONS

Education: Bachelor's degree in Nursing

Experience: A minimum of 3-5 years of experience working in an acute inpatient psychiatric setting as a treatment team member and/or utilization management, or a minimum of three years utilization management experience within a payer organization.

License: CA RN license

Additional Requirements: Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Solid understanding of acute inpatient psychiatric hospital operations, including both mental health and substance abuse treatment.

Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.

STANDARDS OF PERFORMANCE:

• Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer's criteria.
• Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
• Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.
• Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
• Facilitates physician reviews with payers as required.

PHYSICAL, MENTAL, AND SPECIAL DEMANDS

THIS SECTION DESCRIBES HOW AN EMPLOYEE IN THIS POSITION CURRENTLY PERFORMS THE FUNCTIONS OF THIS POSITION. MODIFICATIONS TO THE MANNER IN WHICH THIS JOB MAY BE PERFORMED WILL BE REVIEWED ON A CASE BY CASE BASIS.

1. Ability to stand, or walk up to six hours, sit for up to two hours.
2. Ability to spend 20% of the workday outdoors in temperatures varying from 30-100F and 80% of the workday indoors in temperatures varying from 60-85F.
3. Ability to occasionally push/pull wheeled carts from 200lbs. (i.e. crash carts, patient on stretchers or in wheelchairs).
4. Ability to frequently lift and carry up to 10 pounds; occasionally lift and carry up to 100lbs.
5. Ability to see well enough to read written materials.
6. Ability to discern a variety of odors.
7. Ability to handle hazardous/infectious waste on an occasional basis.
8. Ability to work in an environment where the noise level is frequently high; where chemicals are frequently used in cleaning; where mechanical and electrical hazards may occasionally be present; and where dust, mist and stream are frequently generated in housekeeping tasks.
9. Ability to respond to exposure to blood and bodily fluids.

Additional Requirements:

A strong knowledge of The Joint Commission, HCFA, OSHA regulations, and patient rights standards and all other applicable federal and state laws and regulations governing mental health care facilities.

One of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. UHS is recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500 and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.

EEO Statement:

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice:

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.