Utilization Review Coordinator

The Utilization Review Coordinator performs all functions related to hospital resources and reimbursement. Utilization Review functions as liaison between payors, the business office, and treatment team, providing information and feedback to assist in optimum patient care and reimbursement.

MINIMUM QUALIFICATIONS

• Master's degree from an accredited college or university in Social Work, Counseling Psychology, or related mental health field or:
• AD in nursing, Washington State RN license or Agency Affiliate working toward independent licensure within 2 years.
• A minimum of two (2) years' experience in a behavioral health setting.
• BLS, first aid, Handle with Care, and Verbal De-Escalation certifications to be provided by INBH

PREFERRED QUALIFICATIONS

• BSN
• Three (3) years previous direct clinical experience in a mental health or related healthcare setting
• LICSW, LMFT, LPCC, LMHC or applicable license

1. Confirm preauthorization of all admissions.
2. Perform continued stay reviews as required by individual payors providing justification for level of care.
3. Communicate with the business office any information that pertains to patient insurance status.
4. Maintain accurate records of interactions with insurance companies, managed care organizations, regional support networks, or other health review organizations including date of interaction, name of person contacted, and number of days certified.
5. Attend treatment planning meetings and oversee the coordination of care to patients in respect to the available financial resources which includes notifying attending physician/treatment team of actual or potential denial.
6. Assist in appeal of any denied dates and document interactions or written communication including name of company, dates denied, and appeal status.
7. Assist in discharge planning including assessing referrals from managed care organizations and working with payors to flex benefits and direct care to most appropriate level of care.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

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