Utilization Review Coordinator

4 days ago


Lebanon, Pennsylvania, United States Acadia Healthcare Full time
Job Summary

Acadia Healthcare is seeking a highly skilled Utilization Review Coordinator to join our team. As a key member of our healthcare team, you will be responsible for ensuring that patients receive the necessary care and services to achieve optimal health outcomes.

Key Responsibilities
  • Utilization Review: Act as a liaison between managed care organizations and our facility's professional clinical staff to ensure seamless communication and coordination of care.
  • Case Management: Provide case management and care coordination services for clients/patients/residents, ensuring optimum utilization of resources and compliance with external agencies and referral sources requirements.
  • Documentation and Charting: Assist the admissions department with pre-certifications of care and provide ongoing support and training for staff on documentation and charting requirements.
  • Quality Reviews: Conduct quality reviews for medical necessity and services provided, identifying areas for improvement and implementing changes as needed.
  • Appeals and Disputes: Initiate and complete the formal appeal process for denied admissions or continued stay, ensuring that patients receive the necessary care and services.
Requirements
  • Education: Bachelor's degree in a related field, such as healthcare administration or social work.
  • Experience: Minimum 2 years of experience in a utilization review or case management role, preferably in a healthcare setting.
  • Skills: Strong communication and interpersonal skills, with the ability to work effectively with patients, families, and healthcare professionals.
  • Knowledge: Familiarity with managed care organizations, insurance plans, and healthcare regulations, as well as experience with electronic medical records and other healthcare software.
Benefits
  • Medical, Dental, and Vision Insurance: Comprehensive health insurance package, including medical, dental, and vision coverage.
  • Flexible Spending Accounts and Healthcare Savings Accounts: Flexible spending accounts and healthcare savings accounts to help you save for healthcare expenses.
  • Company-Paid Basic Life Insurance and AD&D: Basic life insurance and accidental death and dismemberment (AD&D) coverage, paid for by the company.
  • Supplemental Life Insurance and AD&D: Optional supplemental life insurance and AD&D coverage, available for purchase by employees.
  • 401(k) Plan: Company-matched 401(k) plan, allowing you to save for retirement.


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