Utilization Review Coordinator

🕒 Julho 28

🔔 Pennsylvania – Remoto

🔔 Pennsylvania – Remote

💵 $20 / hora

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

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Pyramid Healthcare

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

🏥 Saúde

🧘 Bem-estar

Healthcare • Wellness

Pyramid Healthcare é um sistema de saúde comportamental integrado que oferece tratamento personalizado para transtornos por uso de substâncias, condições de saúde mental e transtornos alimentares em vários níveis de cuidados (desintoxicação, internação, ambulatorial) e via telessaúde. Fundada em Altoona, PA, opera uma família de programas e marcas afiliadas focadas em cuidado clínico integrado, centrado na pessoa, educação e treinamento da força de trabalho, e expansão multiestadual para melhorar os resultados de recuperação e o bem-estar da comunidade.

Descrição

• Perform admission, continued stay and discharge reviews on all managed care clients. • Maintain positive relationships with referral sources and insurance companies. • Track admissions, continued stay and discharge ASAM requirements for county referrals. • Maintain organized system of reporting to counselors when ASAM’s are due and when review calls are to be made. • Maintain current insurance eligibility information through EVS, Navinet, etc. • Monitor Census for accuracy of funding. • Attend clinical staffing to obtain information for client reviews. • Maintain daily UR database accurately. • Perform Act 106 reviews and follow up appeals. • Track all county referrals for documentation of admission calls. • Maintain and participate in chart reviews to ensure proper paperwork is in place. • Work directly with Billing Department to reduce uncovered days of funding. • Investigate cases with insurance and referral sources to recuperate lost days of funding. • Report to the Assessment Manager on a weekly basis. • Manage all self-pay clients and clients with copays, deductibles, coinsurance and liabilities. • Reduce client balances. • Other duties as assigned.

🎯 Requisitos

• Associate Degree or equivalent required; Bachelor of Science in Behavioral Health • Intermediate knowledge of computer skills and the internet • Microsoft Office experience (Excel- Intermediate level, Word- Intermediate level) • 3-5 years’ experience in Utilization Review or related position in a healthcare setting.

🏖️ Benefícios

• Medical, Dental, and Vision Insurance • Flexible Spending Accounts • Life Insurance • Paid Time Off • 401(k) with Company Match • Tuition Reimbursement • Employee Recognition Programs • Referral Bonus opportunities • And More!