Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Malvern Behavioral Health is currently seeking a full time Utilization Management Coordinator for our brand new Acute Inpatient units location in South Philadelphia! This position is a full time, benefit eligible position!
Position Summary: To conduct continued stay reviews of medical record documentation using pre-established criteria and to provide updated progress reports to third party payers in order to receive certification for payment. This individual will perform all utilization reviews for acute psychiatric and residential drug and alcohol clients.
Summary of Essential Position Functions:
Supervisory Responsibilities: None
Benefits
This position is a full time, benefit eligible position. Benefits offered include, but not limited to:
Medical Insurance
Dental Insurance
Vision Insurance
Life Insurance
Paid Time Off
401K plan with company match
Qualifications:
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. This position requires individuals that are client focused; team oriented; great interpersonal and communication skills; flexible to sudden changes in workload, emergency or staffing; dependable; problem solving skills; focused on compliance and performance quality. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
Education and/or Experience: Master's Degree or graduate of an accredited nursing program with licensure in the state of Pennsylvania. Previous utilization review experience preferred.
Technical/Computer Skills:
Microsoft office and billing experience preferred. Requires much independent action and decision making and ability to organize own work. Knowledge of facility systems and organization as they pertain to medical records and organization review. Knowledge of medical terminology, medical record format and content.
Work Environment and Hazards:
Risk of exposure to communicable disease. Possible exposure to intoxicated, disruptive, and/or agitated patients. Protected from weather conditions.
Physical Requirements:
Sedentary work primarily – lifting 10 lbs. maximum
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.*
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