Utilization Review Coordinator - RN

Utilization Review Coordinator - RN

Emerald Coast Behavioral Hospital provides inpatient treatment services to children, adolescents and adults at our 86-bed facility in Panama City, FL and outpatient services to adolescents and adults at our three outpatient centers located throughout the Florida Panhandle. Additionally, we offer specialized treatment for active duty military members through our Military Resiliency Program, specialized chemical dependency treatment and TMS therapy for chronic depression.

Visit us on-line at: https://emeraldcoastbehavioral.com/

The Utilization Review Coordinator - RN facilitates optimal reimbursement through accurate certification and complete chart documentation. Conducts concurrent admission and continued stay reviews based on utilization review criteria. Refers and consults with multidisciplinary team to promote appropriate continued stay or discharge in the absence of definitive documentation and/or review criteria to support hospital stay.

Job Duties/Responsibilities:

• Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer's criteria.
  * Facilitates optimal reimbursement through certification process. Conduct concurrent admission and continued stay reviews.
  * Obtains initial certifications for urgent and emergent admissions and stay certifications.
  * Facilitates physician reviews with payers as required.
  * Enters authorization and days approved data into financial and clinical information systems to facilitate hospital billing.
  
• Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
  * Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
  
• Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators. Maintains denial log.
• Contributes to monthly utilization data trends using hospital data tools to report for the overall operation.
• Audits Medicare charts according to LCD standards. Ensures Medicare certifications are timely and accurate. Report's findings to appropriate parties. Makes recommendations for solution.

Benefit Highlights:

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Requirements:

• Associates Degree in Nursing from an accredited curriculum. Bachelor's degree preferred.

• Active Florida State RN License or Compact License

• Two (2) years healthcare experience required. Behavioral health and/or utilization review experience preferred.

• Ability to work 5:30am-2pm

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.

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