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Deerfield Beach

    Utilization Review Coordinator - Deerfield Beach, United States - BayMark Health Services

    BayMark Health Services
    BayMark Health Services Deerfield Beach, United States

    1 week ago

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    Description


    Position at BayMark Health Services

    Residential - Utilization Review Coordinator

    Role and Responsibilities
    • Manages and performs utilization reviews to ensure adherence to federal regulations and payer requirements
    • Assists in maintaining records, answering correspondence and preparing and disseminating reports.
    • Familiar with treatment concepts, practices and facility procedures that impact patient care
    • Applies approved medical necessity criteria towards conducting admission and continued stay record reviews
    • Acts as liaison with third party payers, managed care companies and billing company around communication specific to authorizations for approved patient admissions, continued stay, discharge planning and aftercare.
    • Completes all utilization reviews for Detox, Residential, PHP, IOP and Community IOP levels of care.
    • Sends out admission notifications when assessments are complete.
    • Answers any questions regarding scheduling, etc.
    • Obtains approval for alternative levels of care.
    • Ensures that insurance company's specific questions are addressed in Utilization review interactions - may require communication with clinicians and providers.
    • Communicates denials or possible denials with treatment team to coordinate discharge plan.
    • Requires after hours communication (text, email) with Chief Executive Officer, facility financial representatives or billing company when admission nursing assessment is complete.
    • Occasionally provides information that billing company may send to appropriate parties.
    • Adhere to all confidentiality laws and maintain ethical, professional boundaries with clients.
    • Active participant in performance improvement and quality assurance initiatives that relate to documentation, specific payer initiatives and any payer-initiated action plans to improve facility performance
    • Communicates any concerns relating to documentation and patient care needs to the appropriate departmental leader based on review of patient charts.
    • Active participant of facility treatment team meetings
    • Applies knowledge of managed care, pre-certification, concurrent reviews, medical/psychiatric diagnoses, medications and insurance payment practices.
    • Helps with any other related activities or duties that are required.
    Qualifications and Education Requirements
    • High School diploma or equivalent
    • 3+ years' experience in healthcare setting
    • Must pass State of Florida criminal background and driving record checks
    Salary Range:

    Salary ranges from $60, $74,000.00 annualized.

    The salary of the candidate(s) selected for this role will be set based on a variety of factors, including but not limited to, experience, education, specialty, and training.

    BayMark offers excellent benefits:
    • 401K match
    • Medical, Dental, Vision Insurance
    • Accident Injury, Hospital Indemnity and Critical Illness Plans
    • Company paid Short & Long Term Disability
    • Company paid Basic Life Insurance
    • Paid Time Off
    • Bereavement Leave
    • Sick Time is based off of home location
    • Employee Referral Program
    Total compensation goes beyond the value on the paycheck. Please consider the total compensation package by contacting us at BayMark Health Services for more information.

    COVID-19 considerations:

    Everyone will be asked to be in compliance with the most recent COVID guidelines from CDC, State, County and City.

    BayMark Health Services a progressive substance abuse treatment organization is committed to the highest quality of patient care. Our ultimate goal is to address the physical, emotional, and mental aspects of opioid use disorder to help each of our patients achieve long-term recovery and an improved quality of life.

    BayMark Health Services is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws.
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