Job Details

Kalamazoo Behavioral Health Hospital is seeking a skilled and experienced Utilization Review Coordinator to join our dedicated team. If you're passionate about optimizing patient care, promoting effective resource utilization, and collaborating within a dynamic healthcare environment, we encourage you to apply!

In this vital role, you'll coordinate patient services across the continuum of care, ensuring effective utilization of health resources and fostering seamless communication with multidisciplinary teams. You'll play a key part in advocating for our patients and ensuring appropriate access to the care they need.

Why Join Kalamazoo Behavioral Health Hospital?

At NPH (National Psychiatric Hospitals), we value our employees and offer a comprehensive benefits package designed to support your professional and personal well-being:

• Competitive Pay Rates: We offer highly competitive salaries for top talent.

• Comprehensive Health Benefits: Enjoy Medical, Dental, and Vision Insurance.

• Secure Your Future: Take advantage of our NPH 401(k) plan with up to a 4% Company match.

• Employee Support: Access to robust Employee Assistance Programs (EAP).

• Generous Paid Time Off: Enjoy a flexible and generous PTO and Time Off Policy.

• Invest in Your Growth: Special tuition offers through Capella University to support your continued education.

• Work-Life Balance: Achieve a healthy work-life balance with ample professional growth opportunities.

• Exclusive Discounts: Employee Discounts through LifeMart for a variety of services and products.

What You'll Do (Key Responsibilities):

As a Utilization Review Coordinator, you'll be instrumental in ensuring efficient and appropriate patient care. Your responsibilities will include:

• Payer Precertification & Concurrent Review: Conduct initial precertification and concurrent clinical reviews with payers to secure necessary authorizations.

• Real-time Documentation: Maintain accurate and timely documentation in our electronic system daily.

• Admission Audits: Perform thorough admission audits to ensure compliance and appropriate billing.

• Compliance Assurance: Ensure providers complete Certificates of Need (CONs)/Renewals of Need (RONs) and CMS certifications.

• Denial Management: Handle reconsiderations, assist with appeals, arrange peer-to-peer level reviews, and report outcomes to leadership.

• Collaboration & Education: Actively work with the business office on appeal/denial resolutions and retrospective reviews, and provide education to nursing staff, leadership, and providers regarding documentation best practices.

• Professionalism & Confidentiality: Consistently demonstrate professionalism in all interactions, maintain effective communication, and strictly adhere to patient privacy and health information protection policies (HIPAA).

• Interdepartmental Rapport: Cooperate and maintain strong working relationships with nursing staff, medical staff, and other departments.

• Regulatory Compliance: Remain knowledgeable of and comply with all applicable federal and state laws, as well as hospital policies.

What You'll Bring (Qualifications):

• Education: Bachelor's degree required in Behavioral Health, Social Work, Counseling, Nursing, or Psychology. Master's degree preferred.

• Experience:

  • Minimum of 5 years of utilization review experience in a hospital setting required.

  • Minimum of 5 years of case management experience, including discharge planning, in a hospital setting required.

• Licensure/Certifications:

  • Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.

  • Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.

• Skills:

  • Strong knowledge of medications.

  • Exceptional time management and organizational skills.

  • Proficient data entry abilities.

  • Excellent written and verbal communication skills.

  • High level of attention to detail and accuracy.