Behavioral Health Utilization Review Coordinator
1 day ago
St. Clare's - Boonton is a leading healthcare provider dedicated to delivering high-quality, patient-centered care. Our team of professionals is committed to upholding our core values of quality, compassion, and community.
Job SummaryWe are seeking a skilled Behavioral Health Utilization Review Coordinator to join our team. The successful candidate will be responsible for ensuring the quality and resource management of patients admitted to inpatient behavioral health units.
Key Responsibilities- Conduct thorough reviews of patient medical records to determine medical necessity, intensity of service, and severity of illness.
- Collaborate with external case managers and managed care organizations to secure pre-authorization, concurrent reviews, and appeals/denials management.
- Assist the treatment planning team in understanding insurance requirements and complete UR audits for billing compliance.
- Develop and implement strategies to achieve quality, clinical, and cost-effective outcomes.
- Bachelor's degree in Social Work, Psychology, or a related field.
- Knowledge of DSM 5 diagnosis and medical necessity criteria for behavioral health levels of care.
- Basic knowledge of psychological and medical terminology.
- Masters degree in Social Work, Psychology, or a related field.
- One year of experience in direct care mental health, case management, discharge planning, or nursing management.
As a member of our team, you will have the opportunity to work with a talented group of professionals who share your commitment to quality and compassion. You will also have access to ongoing training and development opportunities to enhance your skills and advance your career.
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Boonton, New Jersey, United States St. Clare's - Boonton Full timeAbout St. Clare's - BoontonSt. Clare's - Boonton is a leading healthcare provider dedicated to delivering high-quality, patient-centered care. Our team of professionals is committed to upholding the values of quality, compassion, and community.Job SummaryWe are seeking a skilled Behavioral Health Utilization Review Coordinator to join our team. The...
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