Utilization Review Coordinator PRN

Responsibilities

• To provide quality case management services to all patient populations and their families.
• To serve as a member of the interdisciplinary team supporting the organization’s treatment program and philosophy and assure the deliverance of quality treatment to patients and their families.
• To proactively monitor and optimize reimbursement for organization services.
• Maintain appropriate records of the Utilization Review Department.
• Prepare and submit appeals.
• Attend mandatory training.
• Conduct admission reviews and pre‑certs.
• Conduct concurrent and extended stay reviews.
• Prepare and submit appeals to third‑party payors.
• Schedule and conduct treatment team meetings to provide total case management of the patient by reviewing written progress notes from charts and communicating any state or local agency legal requirements to the interdisciplinary team.
• Participate in activities which enhance professional growth and development.
• Demonstrate conduct in keeping with CCBH’s ethical standards.
• Comply with facility safety, infection control and security programs.
• Support facility service excellence standards.

Qualifications

• Graduate of an accredited RN program with a current RN license, or a Master’s in Counseling, Social Work, or a related field.
• Experience in psychiatric nursing is preferred.
• High school, preferably college‑level reading, writing, and math skills.
• Excellent telephone, computer, and communication skills.
• Knowledge of health‑care service delivery systems and third‑party reimbursement; understanding of admission and discharge functions.
• Familiar with medical terminology, diagnostic terms and treatment modalities; knowledge of medical record keeping.
• Strong interpersonal, organizational, evaluative, and time‑management skills; policy interpretation skills.
• Must be familiar with applicable standards and regulations.
• Flexible, detail‑oriented, able to comprehend psychiatric evaluations, consults, labs, etc.; responsive to deadlines; assertive, persistent, and persuasive; able to work with minimal direction or supervision.

Seniority level: Entry level

Employment type: Full‑time

Job function: Health Care Provider

Industries: Hospitals and Health Care

Greenville, SC $75,000.00‑$80,000.00