Location
Stuart, Florida
The Utilization Review Coordinator facilitates patient care and ensures optimal reimbursement by performing daily clinical reviews and securing treatment authorizations. They also collaborate with the multidisciplinary team to manage documentation, handle appeals, and report on utilization data trends.
Candidates must hold a Bachelor's degree in Counseling, Psychology, Social Work, or Human Services, or be a valid Florida licensed RN. A minimum of 1-3 years of experience in a behavioral health setting is required.
Coral Shores Behavioral Health, a subsidiary of UHS, is a beautiful, 80-bed adolescent and adult Baker Act receiving facility, which is located in sunny Stuart, Florida. Our professional staff provide high quality, individualized care to uniquely fit the intensity and severity of each patient’s needs and offer a continuum of mental health and addiction services in a confidential, caring environment that promote crisis resolution, positive self- awareness, personal growth and problem-solving. Coral Shores is open 24 hours a day, seven days a week. For more information about Coral Shores Behavioral Health, please visit our website at https://coralshoresbehavioral.com
The Utilization Review 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. 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. Contributes to monthly utilization data trends using hospital data tools to report for the overall operation. Facilitates physician reviews with payers as required. Performs other duties as assigned/required by this position.
Bachelor Degree in Counseling, Psychology, Social Work or Human Services field or a Valid Florida licensed RN. 1-3 years of experience in a behavioral health setting EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.