Utilization Review Coordinator - PVH

Duties: Provide an ongoing, systematic process for the assessment of the necessity and efficiency of the use of Palo Verde Behavioral Health services, assists in the promotion and maintenance of high-quality patient care through the review and evaluation of clinical practices and the review of patient cases for appropriateness of admission, continued stay and discharge planning. To perform this job successfully, an individual must be able to demonstrate competency in the criteria listed in this job description. The specifications listed below are representative of the knowledge, skill, and ability to meet the minimum requirements for this position. Staff must demonstrate knowledge and skill in provision of services to various populations including children, adolescents, adults, older adults and dually diagnosed patients in an inpatient setting.

Skills: 1 year of full-time related professional experience or graduate-level or specialized education in a specialty area related to the work at Palo Verde Behavioral Health preferred. Hold special knowledge of the T36/Court Ordered Treatment process. Coordinate and ensure authorization of patient's treatment with network and non-network providers; this includes all Medicaid, Private Insurance, and Self Pay clients. Performs the overall action of providing and ongoing, systematic process for the assessment of the necessity and efficiency of the use of Palo Verde Behavioral Health services Assists in the promotion and maintenance of high-quality patient care through the review and evaluation of clinical practices Communication with internal and external entities to facilitate acquisition of resources Maintains an awareness of funding sources needs and status and initiates appropriate action Plans, organizes and or reviews the functions of Palo Verde Behavioral Health case management system to minimize denials of payment Manages, prepares, submits, and conducts follow-up on appeal to third party payers on clinical denials. Reviews payer contracts and regulatory requirements on an ongoing basis, updates pertinent policies and procedures and trains staff on special requirements Conducts post-admission and concurrent reviews and communicates pertinent information to payer and treatment team when needed if applicable. Document all concurrent reviews and retrospective reviews. Alert clinicians of any lack of needed UM documentation for priority completion. Alert Nursing and Clinical Services Director of any abnormalities in the UM process. Provide ongoing data entry in the Network Utilization Management MIDAS software System. Provide timely communication, and assistance to the insured of denials and the appeal process. Gather information and orchestrate needed MD to MD reviews in the UM process. If licensed, may be called upon to utilize therapeutic skills to perform therapeutic interventions, group education, and psychosocial evaluations on an as-needed basis for the populations served. Hold responsibility for all T36/Court Ordered filings and coordination for all patients involved with this process, and related UR Reviews related to T36 process. Support and represent Palo Verde to all outside entities involved in T36 including County officials, attorneys, and outside agencies. Assure the rights of each patient are upheld through the process. Provide these services in a way that assures we are paid for the services rendered by all payers.

Education: Preferred: Licensed as a Registered Nurse in the State of Arizona or be licensed as an LMSW, LPC, MFT or similar AZ Board of Behavioral Health licensure and have a master's degree in a Behavioral Health field (e.g. Counseling, Social Work, etc.) preferred. In lieu of Master's Level/licensure: Bachelor's Degree and three years-experience in administration in a behavioral health or medical inpatient facility serving patients, and special knowledge of an aspect of the UR department that requires special knowledge such as the T36/COT process. If applicable, maintains current licensure adhering to regulations and education hour's requirement of UHS, Arizona, and the Federal government if applicable.

Schedule Notes: Monday - Friday 9a-5p - ACCEPTING RNS WITH EXPERIENCE!!! - Please submit RNs at 52.88 for bill rate
Required Skills: LEADERSHIP SKILLS,
Additional Skills:
Hours Per Day: 8.00
Hours Per Week: 40.00
Languages: English( Speak, Read, Write )
Department: 662 : Palo Verde BH
Job Category: Non-Clinical