UR Coordinator PRN

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 https://coralshoresbehavioral.com

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.
• Performs other duties as assigned/required by this position.

Qualifications:

• Bachelor Degree in Counseling, Psychology, Social Work or Human Services field or a Valid Florida licensed RN.
• 1-3 years of experience in a behavioral health setting

EEO Statement

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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