Utilization Review Coordinator jobs in Kalamazoo, MI

Job Summary :

Performs utilization review with external agencies to ensure payment for medically necessary inpatient services.

Essential Functions :

• Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his / her goals and objectives in a manner that helps others to achieve their goals and objectives.
• Performs ongoing review of charts for inpatient psychiatric patients and partial hospitalization patients based on approved utilization review criteria.
• Refers utilization review issues to physician advisor and treatment team as appropriate
• Appeals denied psychiatric days according to approved procedures.
• Maintains up-to-date information regarding requirements of individual insurance companies, and ensures these requirements are met.
• Participates in hospital utilization review committees as appropriate to psychiatric utilization review duties.
• Documents all communications and updates accordingly.
• Maintains stats regarding denied / uncovered days and length of stay.
• Delivers and tracks the Important Message from Medicare form.
• Acts as the court liaison.
• Assists as needed with phone intakes.

Minimum Qualifications : Bachelor’s degree or commensurate experience in a related field of Psychology or Utilization Review.

Completion of Handle with Care Basic Certification in physical and nonverbal patient management within two months of hire with annual re-certification.

Knowledge, Skills & Abilities : Master’s degree in Psychology, preferred. Previous experience with utilization review, case management or telephone triage desired.

Familiarity with electronic medical records and medical terminology.

Physical Requirements : Constantly sit, see / visual acuity, handle / grasp / feel, talk / hear, lift / carry 1 to 25 lbs.

Frequently stand, walk, reach, bend / twist, lift / carry 25 to 49 lbs. Occasionally lift / carry 50 lbs.

Last updated : 2024-03-23