Psychiatric Utilization Review Coordinator

• Conducts concurrent reviews for all active psychiatric patients todeterminecontinued stay medical necessity
• Completes continued stay reviews within requiredtimeframesbased on payer requirements and internal deadlines
• Assesses clinical documentation to support ongoing authorization
• Communicates review outcomes and next steps to treatment teams as appropriate

• Initiates andmaintainscontact with insurance payers to obtain and verify continued stay authorization
• Documents all payer communications and authorization decisions inappropriate systems.
• Tracks active patient authorizations last covered days and next review due dates
• Provides updated authorization information to clinical teams during rounds and as needed

• Attends and activelyparticipatesin daily or weekly clinical rounds
• Provides real-time updates on each patients authorization status including:
• Last covered day
• Next review due date
• Any pending payer actions or concerns
• Notes any changes in patient status that mayimpactlength of stay or authorization

• Receives and reviews denial notices from payers
• Provides denial letters and supporting documentation to the Appeals Team or UR Supervisor for further action
• Updates supervisor on denial particulars as directed
• Tracks denial patterns and reports trends to supervisor

• Monitors and responds to incoming calls from payers providers and internal departmentsin a timely manner
• Processes incoming faxes related to authorizations denials and clinical documentation throughout the day
• Ensures no voicemail or fax goes unaddressed beyond 24 hours
• Escalates urgent or complex issues to supervisorimmediately

• Maintainstimelyandaccuraterecords of allutilizationreview activities
• Documents all reviews and actions in required systems
• Ensures that notes are complete clear and reflect actions taken and what is pendingby the end of the shift
• Assistswith data collection as requested by supervisor

• Collaborates with Pre-Cert Specialists to ensure smooth handoff betweeninitialcertification and concurrent review
• Communicates authorization updates to crisis team social workers and providers
• Participates in team meetings and contributes to process improvement discussions

• Maintains knowledge of medical necessity criteria for psychiatric continued stay reviews
• Understands requirements for Medicare Medicaid managed care and commercial insurance coverage
• Ensures compliance with HIPAA regulations andmaintainsconfidentiality of patient information
• Demonstrates knowledge of inpatient psychiatric treatment and documentation requirements

• Bachelors degree in healthcare administration Psychology Social Work or related field; RN preferred
• Relevant experience may be considered in lieu of degree

• Minimum 1-2 years of experience inutilizationreview healthcare administration or related rolerequired
• Experience working with psychiatric or behavioral health populations strongly preferred
• Familiarity with Medicare Medicaid and commercial insurance requirements preferred
• Experience with InterQual/MCG criteria preferred

• Working knowledge of medical necessity criteria for psychiatric continued stays
• Understanding of insurance authorization processes and terminology
• Familiarity with psychiatric diagnoses DSM-5 and levels of care
• Knowledge of HIPAA and confidentiality requirements

• Strong organizational skills and attention to detail
• Excellent verbal and written communication skills for interacting with payers and clinical teams
• Ability to prioritize multiple tasks and respond to time-sensitive requests
• Proficiencywith electronic medical records (Cerner preferred) and Microsoft Office (Outlook Excel Word)
• Critical thinking and problem-solving abilities
• Ability to track and trend denial patterns

• Ability to work independently and manage own caseload
• Capacity to remain focused despite frequent interruptions (calls emails faxes)
• Ability toparticipateeffectively in rounds and communicate clearly with clinical staff
• Flexibility to adapt to changing priorities and payer requirements
• Commitment to accuracy and thorough documentation
• Ability to escalate appropriately when stuck or uncertain

• Full-time position Monday-Friday with potential for occasional extended hours based on patient needs
• Work is performed in an office setting within a hospital environment
• May require sitting for extended periods while completing computer-based tasks
• Frequent telephone and computer use
• Regular participation in clinical rounds

• Paid Sick Time - effective 90 days after employment
• Paid Vacation Time - effective 90 days after employment
• Health vision & dental benefits - eligible at 30 days following the 1st of the following month
• Short and long-term disability and basic life insurance - after 30 days of employment

Required Experience:

IC