Utilization Review Coordinator(
6 days ago
Utilization Review Coordinator(JOB SUMMARY: The Inpatient Behavioral Health Social Worker in Utilization Review is responsible for evaluating the medical necessity, appropriateness, and efficiency of behavioral health services provided to patients in an inpatient setting. This role ensures compliance with regulatory standards and payer requirements while supporting optimal patient care and resource utilization. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care, promoting clinical best practice, and ensuring all patients receive “the right care, at the right time, and in the right setting”. KEY RESPONSIBILITIES: · Conduct utilization reviews for inpatient behavioral health admissions, concurrent stays, and discharge planning. · Apply clinical criteria (e.g., InterQual, Milliman) to assess medical necessity and level of care. · Collaborate with physicians, nurses, and treatment teams to ensure appropriate care delivery. · Demonstrates thorough knowledge in the application of behavioral health criteria · Communicate with insurance providers to obtain authorizations and manage denials or appeals. · Communicates payor criteria and issues on a case-by-case basis with multidisciplinary team and follows up to resolve problems with payors as needed; initiates peer to peer when appropriate. · Contacts the attending physician for additional information if the patient does not meet the appropriate medical necessity criteria or in accordance with CMS rules and regulations for continued stay. · Supports multi-disciplinary strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes. · Maintain accurate documentation of reviews, authorizations, and clinical decisions. · Monitor patient progress and recommend transitions to lower levels of care when appropriate. · Participate in interdisciplinary team meetings and contribute to care coordination. · Ensure compliance with HIPAA, CMS, and other regulatory guidelines. · Identify high-risk cases and escalate concerns to clinical leadership as needed. · Support quality improvement initiatives related to utilization management. · Performs all other duties as assigned. QUALIFICATIONS/REQUIREMENTS: · Master’s degree in Social Work (MSW). · Active state licensure (e.g., LCSW, LMSW). · 2+ years of experience in behavioral health, preferably in inpatient or managed care settings. · Prior experience in utilization review or case management strongly preferred. · Familiarity with clinical review tools (InterQual, Milliman). · Strong understanding of behavioral health diagnoses, treatment modalities, and discharge planning. · Excellent communication, negotiation, and documentation skills. · Proficiency in electronic health records (EHR) and utilization management software. COMPETENCIES: · Comprehensive knowledge of the health care reimbursement system. · Demonstrated skill in creative problem solving, facilitation, collaboration, coordination, and critical thinking. · Excellent demonstrated oral, written and communication skills. · Proficiency in the use of work processing and spreadsheet application. · Working knowledge of healthcare reimbursement and available community resources. · Must have strong computer skills and the ability to access internet and other programs applicable to Waterbury Hospital procedures. · Perform automated functions that fall within job responsibility.PIff741690258b-30511-38890323
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Utilization Review Coordinator(
4 days ago
Waterbury, United States Waterbury Hospital Full timeJOB SUMMARY: The Inpatient Behavioral Health Social Worker in Utilization Review is responsible for evaluating the medical necessity, appropriateness, and efficiency of behavioral health services provided to patients in an inpatient setting. This role ensures compliance with regulatory standards and payer requirements while supporting optimal patient care...
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Utilization Review Case Manager
6 days ago
Waterbury, United States Waterbury Hospital Full timeUtilization Review Case Manager SCOPE OF POSITION: The Utilization Review Case Manager (UR CM) works in collaboration with the physician and interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers....
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Vocational Floor Coordinator
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Waterbury, Connecticut, United States We Do .er Full time $20 - $24Job Details Level: Experienced Job Location: Chase River Road - Waterbury, CT Position Type: Full Time Education Level: High School/GED Salary Range: $ $24.00 Hourly Job Shift: First Shift Job Category: Direct Support Professional DescriptionRewarding Longevity Incentives AwaitJoin our team and earn a $500 longevity...
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RN Case Coordinator
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Waterbury, United States Hartford Hospital Full timeLocation Detail:27 Jefferson St - HH Data Bld (10020)Shift Detail:Per diemWork whereevery momentmatters.Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.Hartford Hospital...
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RN Case Coordinator
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Waterbury, United States Hartford Hospital Full timeLocation Detail: 27 Jefferson St - HH Data Bld (10020)Shift Detail: 36 hrs/week, rotating weekends and holidaysWork where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most...
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Registered Nurse – Heart Failure Coordinator
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Waterbury, United States Yale New Haven Health Full timeOverviewTo be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.At Bridgeport Hospital, we are committed to providing quality...
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Nurse Coordinator
6 days ago
Waterbury, CT, United States Yale New Haven Health Full timeRegistered Nurse – Heart Failure Coordinator at Yale New Haven Health summary: The Registered Nurse – Heart Failure Coordinator assesses, plans, implements, and evaluates individualized patient care focusing on heart failure and neuro patients under nursing supervision. This role involves coordinating care plans, educating patients and families,...
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Administrative Coordinator
3 weeks ago
Waterbury, United States Magellan Financial & Insurance Services, Inc. Full timeThe Opportunity: Be the Backbone of a Premier Financial Advisory FirmYou are an organizational powerhouse who thrives on order, accuracy, and execution. You prefer being the engine behind the scenes rather than the salesperson in the spotlight. You want a career where your obsession with details is not just appreciated—it is the mission-critical foundation...
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Administrative Coordinator
1 week ago
Waterbury, United States Magellan Financial & Insurance Services, Inc. Full timeThe Opportunity: Be the Backbone of a Premier Financial Advisory FirmYou are an organizational powerhouse who thrives on order, accuracy, and execution. You prefer being the engine behind the scenes rather than the salesperson in the spotlight. You want a career where your obsession with details is not just appreciated-it is the mission-critical foundation...
