Behavioral Health Utilization Management Coordinator

2 days ago


Bronx, New York, United States BronxCare Health System Full time

Job Summary:

The Behavioral Health Utilization Management Coordinator will play a critical role in ensuring the efficient and effective management of patients admitted to psychiatry or substance abuse units. This position requires a strong understanding of nationally recognized criteria for admission and a keen eye for detail to ensure that all patients meet the necessary requirements for certification and reimbursement.

Key Responsibilities:

  • Review and monitor all patients admitted to psychiatry or substance abuse units for appropriateness of admission according to nationally recognized criteria.
  • Monitor discharge plans and continued stays to ensure that patients are receiving the necessary care and services.
  • Provide clinical information to managed care plans and other intermediaries to secure certification status and reimbursement for the hospital.
  • Collaborate with physicians, social workers, and nursing staff to ensure that discharge plans are implemented timely and communicated to health plans and executed within appropriate length of stay allowances.
  • Work under the direction of the Case Manager assigned to Behavioral Health to ensure that all patients are reviewed and certified.
  • Collaborate and communicate with all members of the Behavioral Healthcare team to ensure that patients designated for admission have all necessary documentation to meet admission criteria for reimbursement purposes.
  • Facilitate discharges and assist the discharge planning process by identifying delays and barriers to discharge.

Requirements:

  • Minimum of three (3) years experience specifically in Behavioral Health Utilization review and case management.
  • Managed Care or Discharge Planning experience in Behavioral Health is a plus.
  • Bachelors/Masters degree.


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