Utilization Review Coordinator

About Us

HEALING THE BODY AND MIND

Founded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have previously been unable to, largely due to the patient’s underlying medical issues. Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for both neuropsychiatric and complex medical care issues. This proven approach provides unrivaled quality care for all of our patients. We have multiple locations throughout the United States and are continuing to add locations to ensure better access to our unique model of care.

Overview

Doctors NeuroPsychiatric Hospitals is looking for a PRN Utilization Review Coordinator to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources, and collaborating with multidisciplinary teams.

Benefits of joining NPH

• Competitive pay rates
• Medical, Dental, and Vision Insurance
• NPH 401(k) plan with up to 4% Company match
• Employee Assistance Program (EAP)
• Generous PTO and Time Off Policy
• Special tuition offers through Capella University
• Work/life balance with great professional growth opportunities
• Employee Discounts through LifeMart

Responsibilities

• Filing documents as needed.
• Initial Precertification with payors.
• Concurrent Clinical review with payors.
• Document in the electronic system daily in real time.
• Admission audit.
• Ensure that CON’s/RON’s and CMS certifications are completed by the provider.
• Consistently demonstrate professionalism with all internal and external customers as evidenced by positive customer and peer feedback.
• Communicate effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
• Maintain knowledge of current trends and developments in the field by reading appropriate books, journals, and other literature and attending related seminars or conferences.
• Maintain a professional approach and assure protection and privacy of health information as attained through written, electronic, or oral disclosures.
• Cooperate and maintain good rapport with nursing staff, medical staff, and other departments.
• Seek guidance and remain knowledgeable of, and comply with, all applicable federal and state laws, as well as hospital policies that apply.
• Comply with hospital expectations regarding ethical behavior and standards of conduct.
• Comply with federal and hospital requirements in the areas of protected health information and patient information.
• Assist with reconsiderations and appeals as needed, arrange peer-to-peer level reviews, and report the outcomes to the VP of Care Management and Team.
• Provide education to nursing staff, leadership team, and providers regarding documentation.
• Actively work with the business office regarding resolution of appeals/denials and retrospective reviews.

Qualifications

Education: An undergraduate or graduate degree in behavioral health or a Registered Nurse (RN)

Licensure: QMA, CMA, CCM, ACM or MA (preferred)

Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail-oriented.