Utilization Review Coordinator, PRN - UofL Health

Overview

We are Hiring at UofL Health Utilization Review Coordinators!

Location: Peace Hospital 2020 Newburg Rd. Louisville, Kentucky 40205 

Shift: PRN

About Us

UofL Health – Peace Hospital, is a private, non-profit behavioral health hospital. One of the largest behavioral health facilities in the nation, Peace Hospital is known for providing care for children, adolescents, and adults. It’s Kosair Charities Children’s Peace Center is the largest and most comprehensive private provider of youth inpatient behavioral health services in the country. The hospital was the nation’s first behavioral health care center to open a retail pharmacist operated, long-acting injection clinic. The clinic was established to help people adhere to prescribed medications for behavioral health conditions, such as substance use and psychotic disorders.

Our Mission

As an academic health care system, we will transform the health of the communities we serve through compassionate, innovative, patient-centered care.

Responsibilities

Job Summary

The Utilization Review coordinator performs activities which support the Utilization Management functions.  They are responsible for the delivery of the Utilization Management process including but not limited to: making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews.   The employee communicates with physician and case managers regarding payor approval/denial of admission and continues stay review. They process payor denials and retro reviews, promote optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission, and values of UofL Health, assumes responsibility and accountability for the appropriate utilization of facilities and services and serves as a resource to physicians.  The employee conducts admission and concurrent reviews including observation and inpatients, identifies patients who do not meet criteria and takes action to ensure patients are cared for in the most appropriate level of care; coordinates care in conjunction with other members of the interdisciplinary healthcare team to provide and facilitate optimal health and financial accountability.  This employee utilizes effective decision-making; maintains confidentiality of information; actively supports organizational goals and objectives by providing needed information to divisions and departments.

Qualifications

Job Requirements

• Bachelor of Science in Nursing (required)
  • An RN with a bachelor’s degree in Business, Health Care Administration or equivalent on the condition that they enroll in a BSN program within one year of employment and complete the BSN within three years of employment OR Master’s Degree in Social Work, Counseling Psychology, Clinical Psychology, Family and Marriage Therapy, Mental Health Counseling, Health Administration, or other related fields
• Three (3) years of clinical hospital experience

Preferred Experience

• Active Kentucky Registered Nurse License or compact license with privileges to work in Kentucky (preferred) Or Current Licensed Clinical Social Worker (LCSW), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or Licensed Psychological Associate (LPA) in the state of Kentucky (preferred)
• Additional (1) year experience in case management/utilization management (preferred)
• Three years’ experience with Behavior Health experience (preferred)

Benefits & Perks

• Competitive Pay & Benefits Options
• Paid Vacation, Sick days, and Holidays
• Free tuition to UofL for Part- and Full-time employees for Child/Spouse/Domestic
• Partner401K with Employer Match
• Opportunities for Advancement

#LI-DNI