UR COORDINATOR

Utilization Review Coordinator

This is a specialized coordinating position with a mission of ensuring Remarkable Care for our patients. This position is responsible for submitting continued stay medical necessity reviews to multiple Managed Medicare and Medicaid plans, Managed Care Organizations, external reviewers and other payers in an inpatient and outpatient hospital setting. Also is responsible for:

-Data entry into our review platform.

-Review or audit of records to ensure appropriate documentation of medical necessity.

-Provide educational opportunities for clinical staff to improve medical necessity documentation.

We are seeking a candidate with a working knowledge of Partial Hospitalization (PHP/IOP) and ECT services.

In the event concurrent denials cannot be determined by providing additional clinical information and/or documentation, the Utilization Review Coordinator arranges a peer to peer discussion according to hospital and payer requirements. This may range from actually coordinating a meeting time or simply sharing contact information with both parties. Results of the peer to peer are communicated to the treatment team and documented in our case management system.

Other responsibilities include supporting the physician and multidisciplinary treatment team in the provision of patient care by ensuring the appropriate level of care. The utilization management team will collaborate with other interdisciplinary team members to develop and participate in a systematic approach to denial management. The UM team actively participates in the denial management process to improve reimbursement by optimizing revenue recovery due to inappropriate level of care, failure to meet medical necessity, and/or severity of illness.

Bachelor's Degree from an accredited college or university in Social work, Counseling, Nursing or other related fields is preferred.