Job Details

Utilization Review (UR) Coordinator- Full-Time
Why Cottonwood Creek?
Cottonwood Creek Behavioral Hospital provides high-quality, specialty behavioral health services for individuals with mental health and substance abuse issues. Our success is a reflection of the excellence and dedication of our employees at every level of our facility. The culture of our hospital is built around service. All jobs performed on our team are worthwhile and every employee makes a difference. If you are looking for an opportunity to grow personally and professionally while delivering compassionate, quality care we encourage you to explore career opportunities with Cottonwood Creek.
POSITION SUMMARY:
Responsible for developing and implementing systems for the authorization, concurrent, and retrospective review of inpatient admissions and services. Position supervises staff and the quality, efficiency, and effectiveness of services delivered.
PRIMARY DUTIES:
UTILIZATION REVIEW MANAGEMENT
- Obtain authorization for each admitted patient.
- Review and monitor each step of the authorization process to proactively identify potential problems.
- Interact with physicians and therapists constantly to assure patient assessment and treatment plan is accurately and consistently reflected in facility documentation.
- Track enrollment status continuously to act on changes and initiate retrospective review as necessary.
- Monitor staff communication with external representatives to ensure it is professional and thorough.
- Maintain cumulative documentation regarding actions initiated by staff and self.
- Conduct reviews to ensure that services and documentation conform to the facility protocols, applicable laws and regulations, and the requirements of funding sources.
CLINICAL TEAM MEMBER
- Collaborate with physicians, nurses, and therapists regarding medical necessity for stay, appropriateness of treatment, and estimated length of stay.
- Attend meetings daily to obtain and present information on patient status, care, and stay.
- Communicate authorization status, issues, or problems to appropriate staff.
PAYER MANAGEMENT
- Obtain and maintain authorization for each patient. Problem-solve issues relating to stay or service.
- Respond quickly and effectively to requests for information.
- Nurture positive and professional relationships with external sources.
APPEAL PROCESS
- Minimize the number of appeals.
- Monitor the authorization for continued stay for each patient, and initiate the appeal process when payment for services is denied due to clinical concerns.
- Coordinate the provision of complete and timely documentation to support the appeal.
- Obtain successful resolution of appeals.
Other Duties
- Other duties as assigned.
Qualifications
QUALIFICATIONS:
Education: Bachelor's degree in Social Work (BSW) preferred, Bachelor's degree in a related field or equivalent experience required.
Experience: Two years clinical experience in a psychiatric setting. Knowledge of medical terminology and insurance and billing practices is essential to this position
Certification/License: CPI/CPR per policy.
Haven Behavioral Healthcare is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce. QUALIFICATIONS:
Education: Bachelor's degree in Social Work (BSW) preferred, Bachelor's degree in a related field or equivalent experience required.
Experience: Two years clinical experience in a psychiatric setting. Knowledge of medical terminology and insurance and billing practices is essential to this position
Certification/License: CPI/CPR per policy.
Haven Behavioral Healthcare is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce.