Ur Coordinator

Responsibilities
River Vista Behavioral Health sits along the bluffs overlooking the San Joaquin River, this brand new, 128-bed facility, will provide high-quality and advanced behavioral health services to residents and visitors in the Central Valley. The new hospital will employ more than 250 people, including clinicians, nurses, mental health technicians, support staff and administration.
We are currently seeking a forward thinking and compassionate UTILIZATION MANAGEMENT(UM) 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.
QUALIFICATIONS
Education: Bachelor's degree in Nursing, Psychology or Social Work (MSW required)
Experience: A minimum of 3-5 years of experience working in an acute inpatient psychiatric setting as a treatment team member and/or utilization management, or a minimum of three years utilization management experience within a payer organization.
License: CA RN, LVN/LPT license
Additional Requirements: Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
Solid understanding of acute inpatient psychiatric hospital operations, including both mental health and substance abuse treatment.
Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.
STANDARDS OF PERFORMANCE:

• 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.
• Facilitates physician reviews with payers as required.

Qualifications
PHYSICAL, MENTAL, AND SPECIAL DEMANDS
THIS SECTION DESCRIBES HOW AN EMPLOYEE IN THIS POSITION CURRENTLY PERFORMS THE FUNCTIONS OF THIS POSITION. MODIFICATIONS TO THE MANNER IN WHICH THIS JOB MAY BE PERFORMED WILL BE REVIEWED ON A CASE BY CASE BASIS.

Ability to stand, or walk up to six hours, sit for up to two hours.

Ability to spend 20% of the workday outdoors in temperatures varying from 30°-100°F and 80% of the workday indoors in temperatures varying from 60°-85°F.

Ability to occasionally push/pull wheeled carts from 200lbs. (i.e. crash carts, patient on stretchers or in wheelchairs).

Ability to frequently lift and carry up to 10 pounds; occasionally lift and carry up to 100lbs.

Ability to see well enough to read written materials.

Ability to discern a variety of odors.

Ability to handle hazardous/infectious waste on an occasional basis.

Ability to work in an environment where the noise level is frequently high; where chemicals are frequently used in cleaning; where mechanical and electrical hazards may occasionally be present; and where dust, mist and stream are frequently generated in housekeeping tasks.

Ability to respond to exposure to blood and bodily fluids.

Additional Requirements :
A strong knowledge of The Joint Commission, HCFA, OSHA regulations, and patient rights standards and all other applicable federal and state laws and regulations governing mental health care facilities.
One of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. UHS is recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500 and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.
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