UR COORDINATOR

Location

Kirkland, WA | United States

Job description

Responsibilities

Fairfax Behavioral Health, located in Kirkland, Washington is looking for a qualified Utilization Review Coordinator.

Overview

Fairfax Behavioral Health Hospital, founded in the 1930's, has served the behavioral health needs to the Greater Puget Sound area for more than 80 years, continuously building a reputation for providing the best most compassionate patient centered care!

The patient population we care for is culturally and clinically diverse, creating a stimulating and rewarding workplace. Our strong team environment and mission allow us to provide friendly services that focus on the highest quality patient care. Fairfax Behavioral Health Hospital offers both inpatient and outpatient support services to communities throughout Western Washington. The Kirkland Hospital is part of the Fairfax expanding network of facilities that support our continuum of care for Behavioral Health to the greater Seattle area.

POSITION SUMMARY

The Utilization Review Coordinator performs all functions related to use of hospital resources and reimbursement.  Utilization Review functions as a liaison between payers, the business office, and the treatment team, providing information and feedback to assist in optimum patient care and reimbursement.

RESPONSIBILITIES

• Performs admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria. Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional inpatient days for treatment. Provides information they need in a logical, concise manner using technical language that accurately describes patient’s condition and need for hospitalization.
• Communicates directly with physicians and other members of the treatment team regarding medical necessity criteria and payer expectations and informs clinical and medical staff on issues that may impact length of stay.
• Inputs all reviews, authorizations, peer to peer requests and denials into Midas and keeps the treatment team and administration up to date on the status of each patient.
• Appeals medical necessity denials as necessary and in coordination with the Business Office. Provides information to physicians to assist them in their role in appeals.
• Assists the admissions department with pre-certifications of care.
• Provides ongoing support and training for staff on documentation and charting requirements, continued stay criteria and medical necessity updates.
• Communicates effectively with co-workers, program, and nursing staff regarding charting deficiencies and problems/issues identified.
• Gathers and develops 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.

QUALIFICATIONS

Education : A Bachelor’s degree in a healthcare related field (Nursing, Counseling, Psychology or Social Work, Behavioral/Mental Health). 

Experience: Minimum of 2 years of direct clinical experience in an acute inpatient psychiatric or mental health care setting or a minimum of 2 years utilization management experience within a payer organization.

Additional Requirements: Completion of CPR, 1 st Aid and Handle with Care/De-escalation training provided by facility. 

Job tags

Salary