Responsibilities Coral Shores Behavioral Health, a subsidiary of UHS, is a beautiful, 80-bed adolescent and adult Baker Act receiving facility, which is located in sunny Stuart, Florida.

Our professional staff provide high quality, individualized care to uniquely fit the intensity and severity of each patient’s needs and offer a continuum of mental health and addiction services in a confidential, caring environment that promote crisis resolution, positive self- awareness, personal growth and problem-solving.

Coral Shores is open 24 hours a day, seven days a week. For more information about Coral Shores Behavioral Health, please visit our website at Position Summary : The Utilization Review Coordinator Facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

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. 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.

Completes quality and timely appeal / denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.

Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.

Contributes to monthly utilization data trends using hospital data tools to report for the overall operation. Facilitates physician reviews with payers as required.

Last updated : 2024-05-01