Utilization Review Specialist

7 days ago


Crown Point, Indiana, United States NeuroPsychiatric Hospitals Full time
About Us

NeuroPsychiatric Hospitals is a leading healthcare provider with a unique approach to treating patients with neurological and medical needs. Our hospital system has been serving patients for over 15 years, and we are committed to delivering high-quality care through our interdisciplinary focus and multi-specialty approach.

Job Summary

We are seeking a highly skilled Utilization Review Coordinator to join our team. As a key member of our clinical operations team, you will be responsible for coordinating patient services across the continuum of care, promoting effective utilization, and monitoring health resources.

Responsibilities
  • Initial Precertification: Work with payors to obtain precertification for patients, ensuring timely and efficient care.
  • Concurrent Clinical Review: Collaborate with payors to review patient care and ensure compliance with regulations.
  • Document Management: Accurately document patient information in our electronic system, ensuring real-time updates and seamless communication.
  • Admission Audit: Conduct thorough audits of patient admissions to ensure compliance with hospital policies and regulations.
  • Certification and Compliance: Ensure that CONs/RONs and CMS certifications are completed by providers, maintaining compliance with federal and state laws.
  • Communication and Collaboration: Develop and maintain positive relationships with internal and external stakeholders, including nursing staff, medical staff, and other departments.
  • Professional Development: Stay up-to-date with industry trends and developments, attending relevant seminars and conferences to enhance knowledge and skills.
  • Confidentiality and Compliance: Maintain the confidentiality and integrity of patient information, adhering to hospital policies and regulations.
  • Appeals and Reconsiderations: Assist with appeals and reconsiderations, arranging peer-to-peer reviews and reporting outcomes to the VP of Care Management and Team.
  • Education and Training: Provide education and training to nursing staff, leadership team, and providers on documentation and other relevant topics.
  • Business Office Collaboration: Work closely with the business office to resolve appeals, denials, and retrospective reviews.
Qualifications
  • Education: Bachelor's or Master's degree in behavioral health or a related field, or a Registered Nurse (RN) degree.
  • Licensure: QMA, CMA, CCM, ACM, or MA licensure (preferred).
  • Skills: Strong knowledge of medications, exceptional time management, data entry, and communication skills, with a focus on detail-oriented work.


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