The Utilization Review Coordinator utilizes the nursing process with individual patients and groups of patients to assist them in meeting their physiological, psychological, safety, and general health needs.

• Review all patients’ admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures.
• Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria.
• Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services.
• Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices.
• Contacts physicians and primary Nurses for clarification of information as necessary.
• Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies.
• Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested.
• Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated.
• Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues.
• Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings.
• Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups.
• Performs special projects or other related work as required or requested.
• Shows ability to communicate in a clear and concise manner.

The ideal candidate would have the following knowledge at time of hire:

· Knowledge of Medical Records procedures, medical terminology and office practices.

· Knowledge of hospital utilization review policies and processes.

· Ability to use data collection techniques, and statistical computations.

· Ability to communicate effectively and professionally with third party insurance agencies.

· Knowledge of DSM and criteria for meeting diagnoses.

· Thorough knowledge of effective and appropriate charting principles.

Education:

Associates degree preferred, min two years’ experience in a mental health setting.

Experience:

One (1) year of experience in psychiatric and/or chemical dependency preferred.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Utilization Review: 1 year (Preferred)
• mental health: 1 year (Required)
• detox: 1 year (Required)
• precertification: 1 year (Preferred)

Work Location: In person