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Utilization Coordinator

2 months ago

Danville, Virginia, United States UHS Full time
Job Summary

This role serves as a key provider of resident-centered services, promoting coordinated and effective treatment by facilitating communication exchange between referral sources, physician/treatment teams, and payors. The Utilization Coordinator will manage timely transitions through the phases of residential care, ensuring seamless and efficient resident care.

Key Responsibilities
  • Facilitate communication regarding resident treatment processes and needs with referral sources and payors.
  • Maintain accurate records of authorizations for residents in treatment.
  • Ensure coordinated and effective resident care, including admission, continued stays, and discharge requirements.
  • Develop and maintain positive relationships with external and internal customers.
  • Represent the facility at FAPT meetings and court hearings, as necessary.
  • Ensure continued availability of financial resources throughout residents' stays.
  • Develop systems to review and respond to customer concerns, working with department heads to resolve issues.
  • Review clinical patient data with third-party reviewers to substantiate the need for continued hospital-level care or ongoing participation in treatment programs.
  • Communicate and coordinate third-party reviewers' level of care decisions and expectations with clinical and administrative staff.
  • Assist in preparing Utilization Review Reports as necessary.
  • Coordinate and make Retrospective Appeals to third-party payers.
  • Meet with administrators to discuss key issues and concerns.
Qualifications
  • Basic understanding of medical terminology, residential treatment, clinical science/pathology, and psychiatric disorders.
  • Ability to gather and analyze data.
  • Articulate, assertive, and effective communication skills with families, payors, therapists, and physicians.
  • Initiative, tact, and good judgment.
  • Ability to acquire a clear understanding of treatment priorities and make sound decisions balancing resident and family needs with available resources.
  • Basic computer skills.
Education and Experience
  • Bachelor's degree or three years of professional experience working with children.
Physical Requirements
  • Mental ability to handle stressful and quickly changing situations.
  • Normal auditory processing.
  • Clear verbal speech with no impediments.
  • 50% of time spent seated and talking on the phone or using a computer.
  • Valid Virginia driver's license.