Utilization Review Coordinator, Behavioral Health

Overview

*All positions are located in Fresno/Clovis CA*

 

Opportunities for you!

• Join a Forbes Top 10 CA Employer!
• Free Continuing Education and certification including BLS, ACLS and PALS
• Tuition reimbursement, education programs, and scholarships
• Vacation time starts building on Day 1, and builds with your seniority
• 403(b) retirement plan with up to 8% matching contributions 
• Free parking and electric charging
• Great food options with on-demand ordering
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Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.

 

We know that our ability to provide the highest level of care begins with taking care of our incredible teams. Want to learn more? Click here.

Responsibilities

The Behavioral Health Utilization Review Coordinator is responsible for various aspects of utilization management to ensure that care is rendered in accordance with intensity of service and severity of illness standards at all times during the stay. Works collaboratively with the Case Management team, other departments, and physicians to facilitate efficient and appropriate management of all cases. Accountabilities 1. Reviews the patient care plan of patients who are under treatment for emotional or mental illness to ensure proper utilization of treatment resources.2. Processes patient authorizations, denials and appeals.3. Performs prospective, concurrent and retrospective reviews to determine medical necessity and submits clinical patient information to obtain approval of days and ensure reimbursement for continued inpatient psychiatric treatment according to federal, state and county regulations.4. Identifies documentation deficiencies, admission screening issues, physician practice patterns, case management, and intensity of service issues contributing to payment denials.5. Issues denial letters in accordance with policies, procedures and regulatory guidelines. Informs client and/or responsible party of right to appeal and the appeal process.6. Monitors the length of stay and costs associated per case. Monitors financial aspect of utilization and retrospective review.7. Responsible for analysis and reporting of utilization data (denial, reimbursement, Potentially Avoidable days).8. Collaborates with physicians, Case Management and other teams as needed to expedite timely resolution of situations to include, inappropriate admissions, intensity of service issues and with questions regarding appropriate utilization management.9. Performs other job-related duties as assigned.

Qualifications

Education• Bachelor's Degree in Social Work (BSW) or related field required• Master's Degree in Social Work (MSW) or related field preferred Experience• 2 years of experience in Discharge Planning, Case Management or Utilization Management required• Experience in the utilization review process and insurances preferred• Experience in a Behavioral Health environment is preferred

Disclaimers

• Pay ranges listed are an estimate and subject to change.• If any bonuses are noted, they are only applicable to external hires meeting criteria.