Behavioral Health Utilization Management Coordinator

1 week ago


Madera, United States Universal Health Services Full time
Job Summary

We are seeking a highly skilled Behavioral Health Utilization Management Coordinator to join our team at Universal Health Services. This role will involve facilitating a continuum of service while promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

Responsibilities
  • Facilitate timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid, and commercial) to secure authorization for continued treatment based on payer's criteria.
  • Function 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.
  • Complete quality and timely appeal/denial letters. Participate in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.
  • Work collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
  • Facilitate physician reviews with payers as required.
Requirements

To be successful in this role, you should have:

  • 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.
  • A Bachelor's degree in Nursing.
  • A CA RN license.
  • 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.
Working Conditions

This position requires the ability to stand, or walk up to six hours, sit for up to two hours. The employee must also be able to spend 20% of the workday outdoors in temperatures varying from 30°F to 100°F and 80% of the workday indoors in temperatures varying from 60°F to 85°F.

About Us

Universal Health Services is one of the nation's largest and most respected hospital companies. We offer a competitive salary and benefits package, including medical, dental, and vision insurance, 401(k) plan, and paid time off.



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