Summit Oaks Hospital is seeking a Utilization Review Coordinator (UR Coordinator) to perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing the denial/appeals process, as well as the flow, organization, and reporting of information.

The specific duties of the Utilization Review Coordinator include but are not limited to:

• Obtaining preauthorization for admissions and continued stays according to third party guidelines within one business day of admission (unless otherwise required), including researching and obtaining any necessary insurance contact information, and coordinating scheduled meetings between hospital and insurance doctors.
• Managing and performing the processes for retrospective authorizations and denials/appeals.
• Timely communicating preauthorization outcomes, follow-up instructions, options, and related information to relevant hospital staff and patients. This includes responding to all calls and emails within one business day unless otherwise required.
• Documenting activity in Billing and UR software, and preparing reports for meetings and management review.
• Organizing and filing documents for ease of access in approved locations.
• Assisting in compiling information for data analysis relating to preauthorization and reimbursement.
• Providing assistance to hospital staff in determining the likelihood of insurances covering treatment.
• Maintaining patient confidentiality in accordance with state and federal law.
• Participating in hospital information meetings, required in-service education and training, and hospital-wide performance improvement and compliance activities.
• Promote and incorporate service excellence standards into job responsibilities and interactions. This includes incorporating service recovery skills into difficult patient discussions, and respecting the rights of patients and staff not to participate in or listen to conversations where frustrations and grievances are expressed in an unproductive manner.

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We believe that diversity and inclusion among our teammates is critical to our success.

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Education: Master’s degree from an accredited college or university in social work, mental health is preferred or a Nursing degree. License required : LPC, LCSW Or NJ RN.

Experience: A minimum of two (2) years direct clinical experience in a psychiatric or mental health setting. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities is preferred.