Quail Run Behavioral Health ยท 1 week ago
Utilization Management Coordinator FT
Phoenix, AZ
Full-time
Onsite
Entry, Mid Level
2+ years expQuail Run Behavioral Health is a provider of behavioral health services, and they are seeking a Utilization Management Coordinator. The role involves advocating for patient access to services, coordinating with the treatment team, and ensuring compliance with insurance requirements throughout the patient's stay.
Health CareMedicalPersonal Health
Responsibilities
The UM Coordinator contacts external case managers/managed care organizations for certification and recertification of insurance benefits throughout the patients stay, and assists the treatment team in understanding the insurance companys requirements for continued stay and discharge planning
The UM Coordinator is responsible for having a thorough understanding of the patients treatment through communication with the treatment team
The UM Coordinator advocates for the patients access to services during treatment team meetings and through individual physician contact
Review the treatment plan and advocate for additional services as indicated
Promote effective use of resources for patients
Ensure that patient rights are upheld
Maintain ongoing contact with the physician, program manager, nurse manager, and various members of the team
Collaborate with the treatment team regarding continued stay and discharge planning issues
Advocate that the patient is placed in the appropriate level of care and program
Interface with program staff to facilitate a smooth transition at the time of transfer or discharge
Maintain documentation related to UR activities Assure tracking of insurance reviews, and that reviews are completed in a timely manner
Maintain statistical reports and prepare documentation of significant findings
Communicate insurance requirements to all levels of staff
Provide timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews, and discharges. Update the denial log statistics on an ongoing basis (at least weekly), and initiate appeals through telephone or written communication within 7 to 10 days of denial
Consult with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete
Provide clinical information to managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days
Coordinate with the insurance company doctor in appeals process and denials process
Review assessment information
Communicate with attending physician and program managers, and other providers of service, to assure continuity of care, efficiency, and effective transitions between levels of care
Provide feedback to the attending physician and treatment team members concerning continuing certification of days/services
Communicate with external reviewers and referral sources. Conduct external reviews and maintain documentation of interactions
Ensure that third-party payers are notified of, or participate in, decisions about transitions between levels of care
Qualification
Required
A minimum of two (2) years experience in a healthcare setting or managed care company
Bachelors degree
Preferred
Hospital experience
Masters degree
Company
Quail Run Behavioral Health
Quail Run Behavioral Health is a healthcare center that offers psychiatric care and adolescent treatment services.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Chris Ruble
Chief Executive Officer
Daniel Faught
Chief Financial Officer
Company data provided by crunchbase