Utilization Review Coordinator PD
Utilization Review Coordinator PD
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1 Vacancy
Job Description
Overview
At Saint Clares Health our dedicated team of professionals is committed to our core values of quality compassion and community. As a member of Prime Healthcare Saint Clares Health is actively seeking new members to join its awardwinning team!
Saint Clares Health includesCMS 5Star Ratedhospitals and is an awardwinning provider of safe high quality compassionate care serving the communities of Morris Warren and Sussex counties. Its network of hospitals and healthcare facilities include Denville Hospital Dover Hospital Behavioral Health Centers in Boonton Denville and Parsippany and an Imaging Center in Parsippany among other satellite locations. The hospitals have received multiple quality awards including Leapfrog A ratings for patient safety; Healthgrades recognition for orthopedic surgery treatment of stroke heart care various surgical procedures and more. For information visit .
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race color sex sexual orientation gender identity religion national origin age (subject to applicable law) disability military status genetic information or any other basis protected by applicable federal state or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: for the quality and resource management of all patients that are admitted to inpatient behavioral health units from the point of their admission and across the continuum of the health care management. Responsible for contacting external case managers and managed care organizations for preauthorization concurrent reviews and appeals/denials management throughout the duration of a consumers stay. Assists the treatment planning team in understanding insurance requirements and completes UR audits for billing compliance. The methodology is designed to facilitate and ensure the achievement of quality clinical and costeffective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity intensity of service and severity of illness.
Qualifications
EDUCATION EXPERIENCE TRAINING
Required Qualifications:
1. Bachelors degree in Social Work Psychology or other health related field.
2. Knowledge of DSM 5 diagnosis and medical necessity criteria for behavioral health levels of care.
3. Knowledge of basic psychological and medical terminology.
Preferred Qualifications:
1. Masters degree in Social Work psychology or other health related field is highly preferred.
2. One year of experience in direct care (inpatient or outpatient) mental health case management discharge planning or nursing management is preferred.
#LITS1
Required Experience:
IC
Employment Type
Grant
