Utilization Review Coordinator

UHS•Augusta, GA

12d

About The Position

The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing and accreditation requirements. The Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued stay reviews.

Requirements

Masters level education in social science field (social work, counseling, etc). Must be license-eligible or licensed in Georgia.
Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review.

Nice To Haves

Nurses with a current GA or Multistate RN license encouraged to apply.
LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN preferred.

Responsibilities

Review clinical content of medical records, participate in treatment team meetings, and collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved.
Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4.
Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems, in addition to other job duties.