Utilization Review Coordinator

UHS is one of the largest and most respected hospital management companies in the nation.

The Utilization Review Coordinator is responsible for the oversight of the flow of treatment activities offered to the consumer, including the clinical screening for appropriation of potential admissions, and appropriate level of care, initiation of treatment phase(s), interface with the treatment team, interface with external case managers and managed care organizations, oversight and implementation of discharge planning and customer service.

* Conducts admission reviews and concurrent reviews in accordance with the hospital-wide Utilization Review Plan. * Serves as liaison to 3rd and 4th party reviewers. * Conducts focused reviews as determined by the Utilization Review and/or Quality Assurance Committees. * Maintains all records/data pertaining to the Utilization Review Program. * Participates in staff/M.D. education relative to medical record documentation. * Actively participates in Utilization Review and Peer Review Committee meetings including presentation of reports, statistics, etc. * To lead by example and champion the philosophy of Service Excellence. * Reporting Relationship : The UR Coordinator reports operationally and administratively to the Director of Assessment & Referral.

**Knowledge, Skills and Ability:** * Knowledge of code procedures * Knowledge of case management techniques * Knowledge of consumer assessment, family motivating treatment planning techniques * Knowledge of external review organizations (i.e. managed care, Medicaid). * Knowledge of consumers rights, advanced directives, adult and child abuse laws, and emergency detention * Knowledge of complex consumer care planning * Knowledge of payer resources and financial planning * Knowledge of computers and various software programs * Skill in organizing and prioritizing workloads to meet deadlines * Skill in telephone etiquette and paging procedures * Effective oral and written communication skills * Excellent time management skill. * Strong customer service skills * Ability to adhere to safety policies and procedures * Ability to work as a team player * Ability to demonstrate tact, resourcefulness, patience and dedication * Ability to accept direction and adhere to policies and procedures * Ability to tolerate ambiguity, uncertainty and change * Ability to use effective judgment and maintain confidentiality of information **Requirements:** * R.N. or M.S.W. or other Master’s Level mental health professional licensed or certified in the State of Illinois. * Primary Source Verification shall be required through Illinois Department of Professional Regulations. * Bachelor’s Degree in nursing, psychology or mental/health/human services field is required; Masters preferred. * A minimum of three (2) years direct clinical experience in a medical-psychiatric, psychiatric or mental health setting and at least two years experience in utilization management is required. * Skills in consumer assessment, motivating families and other resources, treatment planning, and communicating with external review organizations or comparable entities is preferred.