UM COORDINATOR IOP

UHS • $104K — $114K *
Madera, CA 93638In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Nursing, Psychology, or Social Work; Master's preferred.
  • CA RN license required; license in Social Work, AMFT, or Mental Health Counseling preferred.
  • 3-5 years in acute inpatient psychiatric settings or utilization management experience.
  • Knowledge of behavioral health managed care and clinical assessment aligned with DSM-V guidelines.
  • Strong communication skills for patient advocacy and negotiating with payers.

Responsibilities

  • Conduct timely daily clinical reviews with various payer types for treatment authorization.
  • Serve as a key member of the multidisciplinary treatment team, guiding on payer expectations.
  • Draft quality appeal and denial letters while supporting post-claims reviews.
  • Ensure documentation from all departments aligns with patient conditions.
  • Analyze and report monthly utilization data trends for operational insights.
  • Facilitate physician reviews with payers as needed.
  • Perform additional duties as assigned.

Benefits

  • Collaborative work environment with multidisciplinary teams.
  • Opportunities for professional development and growth.
  • Role focused on making a positive impact in patient care.
  • Engagement in data analysis for operational improvements.
  • Involvement in appeals and advocacy processes for patient reimbursements.
Full Job Description
Responsibilities

Position Summary:

Facilitates a continuum of service while promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

This position will be for our IOP Outpatient department

QUALIFICATIONS

Education: Bachelor's Degree in Nursing , Psychology, or Social Work. Master's preferred.

Licensure: CA RN license required. License in Social Work, AMFT, Mental Health Counseling preferred

Experience : A minimum of 3-5 years of experience working in an acute inpatient psychiatric setting as a treatment team member and/or utilization management, or years of utilization management experience

RN pay ranges- $50-$55

SW pay ranges- $37-$42

Qualifications

  • Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
  • Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers
  • Solid understanding of acute inpatient psychiatric hospital operations, including both mental health and substance abuse treatment.

    • Essential Job Duties/Responsibilities

  • Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on the payer's criteria.
  • Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
  • Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators
  • Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
  • Contributes to monthly utilization data trends using hospital data tools to report for the overall operation
  • Facilitates physician reviews with payers as required
  • Performs other duties as assigned/required by this position


    • About UHS

    UHS Careers

    Joining UHS presents an unparalleled opportunity to become part of a leading team of healthcare professionals dedicated to making a difference. UHS, known for its commitment to innovation and leadership in the healthcare sector, offers a variety of job opportunities that cater to a diverse range of skills and experiences.

    Explore Job Opportunities

    UHS is actively hiring and offers a wide array of positions, from clinical roles to administrative support. Each position at UHS is designed to challenge team members while providing meaningful service to the community. Explore the current job openings and find a career path that suits professional aspirations and skills.

    Internship Programs

    UHS provides robust internship programs that offer hands-on experience in the healthcare industry. Internships are a cornerstone of professional development, giving participants a chance to deepen practical skills in a real-world setting. These programs are tailored to foster growth and prepare interns for a full-time position within the company.

    Professional Growth and Development

    UHS believes in nurturing the career growth of its team members through comprehensive professional development programs. These include leadership training, diversity training, and continuous education in the latest healthcare practices, ensuring that every team member has the opportunity to advance their career.

    Benefits and Culture

    Employment at UHS comes with competitive benefits designed to support the health, well-being, and financial security of each team member and their families. The company culture at UHS is built on a foundation of respect and inclusion, where diversity is celebrated and every voice is heard.

    Networking and Innovation

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    Applying for a Position

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    * Ladders Estimates

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