Utilization Review Coordinator

Responsibilities

Lighthouse Care Center of Augusta (LCCA) is a multi-discipline behavioral healthcare center that offers mental health services to the communities of surrounding Augusta, Georgia. The Lighthouse Care Center of Augusta is an acute and residential treatment facility providing balanced, top-notch clinical care to children, adolescents and young adults. We provide a carefully-structured and supportive environment, and our education program is accredited through the Georgia Accrediting Commission.

Much more available online at: https://lighthousecarecenters.com/

LCCA is recruiting for a marvelous Utilization Review Coordinator. Under the direction of the UR Manager, the Utilization Review Coordinator will review clinical content of medical records, participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved. Utilization Review Coordinator will ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4. Under the Manager of Utilization Review, the Utilization Review Coordinator will be trained in all aspects relative to timely gathering clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems, in addition to other job duties.

This opportunity provides the following:

UHS is Challenging and rewarding work environment
Growth and development opportunities within UHS and its subsidiaries
Competitive Compensation
Excellent Medical, Dental, Vision and Prescription Drug Plan.
401k plan with company match
Generous Paid Time Off

Qualifications

EDUCATION AND EXPERIENCE

Masters level education in social science field (social work, counseling, sociology, psychology). Must be license-eligible.

Nurses with a current GA or Multistate RN license encouraged to apply.

Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review.

CERTIFICATIONS, LICENSES, REGISTRATION

Valid state driver's license with appropriate endorsement. Current Registered Nurses license.

LANGUAGE SKILLS

Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. Elementary use of computer spreadsheet programs.

REASONING ABILITY

Ability to identify problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Ability to think and act quickly and calmly in an emergency situation and make independent decisions.

PHYSICAL DEMANDS

While performing the duties of this job, the employee is regularly required to sit, stand, walk, talk, and hear; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 10 pounds and occasionally life and/or move a minimum of 50 pounds. Specific vision abilities required by this job include close, distant, and peripheral vision, color and depth perception, and ability to adjust focus. The employee may occasionally be required to restrain clients, using authorized restrain procedures as a last resort for protection of client and staff.

DATA PROCESSING

Must be able to type and accurately enter information into a computer database. Must be proficient in WORD, EXCEL and other related programs.

WORK ENVIRONMENT

The work environment for this position is Residential Facility, Partial Hospitalization, and Acute Hospitalization. While performing the essential functions of this job, the employee will be exposed to clients who may ask inappropriate personal questions, display socially unacceptable personal behaviors, use profanity and sexually explicit phrases, make insulting remarks or threats regarding appearance, age, sex, or race, and exhibit defiance, dishonesty, and assaultive or self-destructive behaviors. The employee is occasionally exposed to outside weather conditions, and may be subject to occasional local travel as required by facility needs. The noise level in the work environment is usually quiet to moderate.

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