Job description
The Behavioral Center of Michigan, an accredited psychiatric hospital providing high levels of psychiatric care to adult patients and committed to person focused care is looking for a Utilization Review Coordinator to be responsible for ensuring the professional assessment, planning, coordination, implementation and reporting of complex clinical data in supporting the operations of the hospitals.
The Utilization Review Coordinator reviews the patient's chart and records clinical information and criteria. He/she will identify areas in the charts that need improvement. He/she will use his/her skills to help educate the staff and physicians regarding charting.
QUALIFICATIONS:
- High School Diploma or equivalent.
- Associate's of Arts or of Science Degree (preferred).
- A minimum of one (1) year of experience in a managed behavioral healthcare facility.
- Medical/psychiatric terminology, anatomy, physiology and concepts of disease
- CMS standards of 401 criteria for both admission and continued stay
- Conducting and reviewing medical records for medical necessity
- Basic ICD-9, CPT coding knowledge
- Regulations as set by the Centers for Medicare/Medicaid Services
- Skill in operating a personal computer utilizing a variety of software applications
- Strong written and oral communication skills
Job Summary:
Perform utilization review in accordance with all state mandated regulations. Maintains compliancy with regulation changes affecting utilization management. Reviews patient recrods and evaluates patient progress. Performs continuing review on medical records and identification and need of on-going hospitalization. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review. Ensures appropriate and cost-effective healthcare services to patients.
Documents review information in the HMS. Communicates results to the case management entity for the specific insurance payer. Enters billing information for services. Receives and processes requests for appeal of denials. Responds to complaints per UR guidelines. Maintains utilization review and appeal logs, as needed.
Analyzes patient records and participates in interdisciplinary collaboration with professional staff. Facilitates education programs and advises physicians and other departments of regulations affecting utilization management. Consults with Social Services Department regarding the level of nursing care and collaborates with other departments in evaluation of projects affecting discharge plans.
Job Type: Full-time
Pay: From $19.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Medical specialties:
- Psychiatry
Physical setting:
- Inpatient
Schedule:
- 8 hour shift
- Monday to Friday
- Weekend availability
Ability to commute/relocate:
- Warren, MI 48092: Reliably commute or planning to relocate before starting work (Preferred)
Application Question(s):
- Are you fully vaccinated against COVID-19?
Experience:
- Utilization review: 1 year (Required)
Work Location: Hybrid remote in Warren, MI 48092
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