- Demonstrates the ability to work closely with the Medical Director, Clinical Director, and all clinical staff to ensure that sufficient documentation is present to justify the clinical necessity and appropriateness of admission and continued stay
- Demonstrates the ability to compile statistical reports and submit findings monthly to the required Committee
- Demonstrates the ability to evaluate and recommend strategies to improve the efficiency with which services are provided and detect and eliminate under or over utilization
- Demonstrates the ability to review cases with insurance/managed care companies/out-of-state entities to include pre-certification, admissions reviews, and continued stay reviews
- Demonstrates the ability to work with Medical Records regarding documents sent to any insurance/managed care company
- Demonstrates the ability to review charts daily, report any deficiencies to the appropriate staff, and assist with getting those deficiencies corrected
- Participates as an integral member of the treatment team including attendance and knowledge of scheduling of treatment team reviews, special case reviews, and treatment formulation. In addition, works with parents, guardians, and family members to encourage active involvement in the treatment of the residents and continuation of active insurance benefits
- Attends meetings, prepares reports, and follows policy and procedures to include patient rights, confidentiality, privacy, and the code of ethics. Participates in performance improvement activities to include staff development and completes all required annual training.
- Demonstrates the ability to oversee the Discharge Planning process for each resident to ensure that the process is complete and timely
- Demonstrates the ability to keep all information updated in the computer system regarding insurance authorizations and assists Corporate in any billing issues
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Vision insurance
- Office
- Monday to Friday
- Waynesville, MO 65583: Reliably commute or planning to relocate before starting work (Required)
- Licensed RN or Bachelor's Degree in the mental/behavioral health field required
- (1) year experience in the Utilization Review process and/or two (2) years clinical experience in a psychiatric facility preferred
- Experience working in a children's services program or in a residential setting is preferred
- Strong organizational skills, communication skills and ability to perform detailed work
- Ability to use the English language and medical terminology effectively and to understand/carry out complex oral and written instructions within a prescribed routine.
- RN (Preferred)
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Utilization Review Coordinator - Waynesville, United States - Perimeter Healthcare - Integrated Behavioral Health
Description
Job DescriptionPerimeter Behavioral of Missouri is looking for a Utilization Review Coordinator to join our team. We are seeking individuals who are committed to improving the lives of those who experience mental health problems.
Perimeter Behavioral of Missouri is daily committed to improving patients' lives by using a patient centered collaborative approach to provide high quality care addressing both the mental and physical well being of our patients. Join our team today
ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited to, the following:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. An individual must be able to perform the duties in a positive work mode and serve as a positive role model and influence for youth and peers. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Job Type: Full-time
Benefits:
To learn more about the company, please visit our website at:
Perimeter Healthcare is one of the leading behavioral health care providers in the country for children, adolescents, adults, and senior adults. We deliver hope to our patients through the delivery of comprehensive and dedicated treatment programs. Our focus and commitment on service excellence is available across several states and in different care settings. Our team ensures our patients receive the required care that they or their loved one needs. We offer several programs for our patients including inpatient acute treatment and residential treatment. We are seeking staff who exhibit daily the following values: C- Compassion A- Accountability R – Respect and E- Empowerment.
EEO
We are committed to providing an environment of diversity and inclusion where equal opportunities are available to all applicants and fellow employees. Perimeter Behavioral Health is an equal opportunity employer regarding all recruitment, training, and selection process within the company regarding race, color, religion, age, sex, sexual orientation, pregnancy, and gender identity, genetic information, national origin, disability status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
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