Utilization Review Coordinator

4 weeks ago

Long Beach, United States COLLABORATIVE NEUROSCIENCE NETWORK LLC Full time

**Facility Overview**

At Ocean View Psychiatric Health Facility, we are committed to serving as a community resource, providing the highest quality of mental health services. Currently, Ocean View operates as an adult 39-bed voluntary acute in-patient facility, offering private rooms and individualized care through a multi-disciplinary approach focusing on compassionate care and best practices. We also provide Intensive Outpatient and Partial hospitalization services to ensure a continuum of care after acute stabilization. We are currently in the process of expanding our Long Beach facility to 80 beds, offering a locked facility setting for those who meet intensive mental health criteria. Additionally, our expansion plans to other areas are progressing rapidly, and we anticipate that our Colton Location in San Bernadino County, will be operational by Summer of 2024.

**Utilization Review Coordinator Position Overview**

**Pay**: $25 - $30 / Hour**

Ocean View Utilization Review Coordinator in our psychiatric health facility plays a crucial role and is responsible for evaluating the necessity, appropriateness, and efficiency of the use of medical services, including inpatient psychiatric care. UR Coordinator works closely with healthcare providers, insurance companies, and patients to ensure that treatment plans align with medical necessity criteria and regulatory guidelines. As a member of the Utilization Review Committee, the employee is responsible for reviewing Patient charts and assessing the hospital use of professional care, services, and procedures.

This includes the medical necessity and appropriateness of:

- Patient admission; re-admission
- Level of care
- Utilization of resources
- Continued hospital stays and corresponding documentation
- Discharge and post hospital care referrals
- Quality improvement
- Insurance coordination
- Compliance
- Interdisciplinary Collaboration
- Multiple admissions

The UR Coordinator will also report findings related to patterns and trends of over-utilization and under-utilization and excessive resource use. Compiles monthly reports and statistics for presentation to the Utilization Review Committee. Works with UR Committee to establish interventions to prevent or resolve utilization problems and to improve systems and processes associated with inefficient or inappropriate delivery of care or services.

Make a difference by providing quality care alongside us at Ocean View

**Minimum Qualifications**
- 2 years of experience in Utilization Review or related position in a healthcare setting.
- Ability to interact and communicate verbally and in writing with seriously and persistently mentally ill Patients, other staff members, and the public.
- Ability to speak, read, and write legibly in English.

**Preferred Qualifications**
- AA degree or bachelor’s degree
- Bilingual English/Spanish +.
- Must speak fluent English. Excellent verbal and written communication as well as strong interpersonal and organizational skills required.
- Medical Records certification preferred.
- Previous JCAHO experience preferred.

**Special Conditions**

Job offer is contingent on successful engagement in our COVID-19 vaccination program (documented proof of being fully vaccinated with 1 booster), live scan fingerprinting/background check clearance, and license/education verification.

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