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Utilization Review CoordinatorWellington Regional Medical Center • Augusta, Georgia, United States
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Utilization Review Coordinator

Wellington Regional Medical Center
  • US
    Augusta, Georgia, United States
  • US
    Augusta, Georgia, United States
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About

Utilization Review Coordinator Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15 years. Located in Augusta, GA, our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff. The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing, and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued stay reviews. Job Duties/Responsibilities:
Review clinical content of medical records Participate in treatment team meetings Collaborate with physicians, therapist, nurses, and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved Ensure input of pre-certifications and continued stay reviews into Midas Follow-up on unfinished pre-certifications from the day before Coordinate with the treatment team on any follow-ups necessary Verify insurance coverage at the first of the month Post patient payments into MS4 Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer-based systems, in addition to other job duties
Benefit Highlights:
Referral Bonus Program Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan Career development opportunities within UHS and its 300+ Subsidiaries!
Qualifications: EDUCATION AND EXPERIENCE: Masters level education in social science field (social work, counseling, sociology, psychology). Must be license-eligible or licensed in Georgia. Nurses with a current GA or Multistate RN license encouraged to apply. Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review. CERTIFICATIONS, LICENSES, REGISTRATION: LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN preferred.
  • Augusta, Georgia, United States

Languages

  • English
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