Position: Utilization Management Coordinator
The UM Coordinator position is responsible for ensuring the provision of quality patient care, effective utilization of available health services, review of medical necessity for continued stay in the hospital, (Completing concurrent reviews with insurance companies for continued stay), some case management, analyzing patient records to ensure compliance with government and insurance company, reimbursement policies, ensuring compliance with insurance, governmental, and accrediting agency standards, and determining patient review dates according to established diagnostic criteria. Must possess good written and oral communication skills.
- Education: (Graduate of an accredited School of Nursing) or
- (Bachelor in Psychology or Social Work),
- (Master Social Work, or related field.
- Currently licensed by the State of S.C. ( Board of Nursing) and/or (Board Social Work) Preferred.
Experience: Two (2), years experience in Utilization Management. Possess the working knowledge of hospital, CMS and other regulatory bodies. Possess the knowledge of medical necessity/level of care criteria.
Special Skills: Demonstrates understanding of psychiatric illness and its treatment including a sound knowledge regarding psychotropic medications, behavior management, and bio-psychosocial functioning across the life span. Demonstrates sound judgement, initiative, integrity, dependability, decision making abilities, excellent command of the English language (written and orally).
Physicial: Light work; exerting up to 20 pounds of force occassionally. Entails pushing and or pulling material is negligible. Requires some sitting, standing and walking.
Enviroment: Inside, to ensure protection from the weather conditions but, not necessary from the temperature changes. Noise level is light to moderate.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Referral program
- Retirement plan
- Tuition reimbursement
- Vision insurance
Medical specialties:
Schedule:
Education:
License/Certification:
- RN or Social work License (Preferred)
Shift availability:
Work Location: In person