Utilization Review Specialist (UR Coordinator)
Company: Oasis Behavioral Health
Posted on: September 19, 2022
- Act as liaison between managed care organizations and the
facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements,
of insurance plans or other managed care organizations (MCOs) and
coordinate the flow of communication concerning reimbursement
- Monitor patient length of stay and extensions and inform
clinical and medical staff on issues that may impact length of
- Gather and develop statistical and narrative information to
report on utilization, non-certified days (including identified
causes and appeal information), discharges and quality of services,
as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services
- Facilitate peer review calls between facility and external
- Initiate and complete the formal appeal process for denied
admissions or continued stay.
- Assist the admissions department with pre-certifications of
- Provide ongoing support and training for staff on documentation
or charting requirements, continued stay criteria and medical
necessity updates. OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
- Associate's degree in nursing (LPN or RN) required. Bachelor's
or Master's degree in social work, behavioral or mental health,
nursing or other related health field preferred.
- Two or more years' experience with the population of the
facility and previous experience in utilization management
- Current licensure as an LPN or RN within the state where the
facility provides services; or current clinical professional
license or certification, as required, within the state where the
facility provides services.
Keywords: Oasis Behavioral Health, Chandler , Utilization Review Specialist (UR Coordinator), Other , Chandler, Arizona
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