UTILIZATION MANAGEMENT COORDINATOR
On-site · Travelers Rest, South Carolina, United States
Job Summary
Utilization Management Coordinator responsible for ensuring quality patient care through effective utilization of health services, concurrent reviews with insurance companies for continued stay, some case management, and ensuring compliance with government, insurance, and accrediting standards. Analyzes patient records to confirm medical necessity per established criteria and determines patient review dates; requires strong written and oral communication skills and the ability to work within regulatory frameworks.
Required Qualifications
- Graduate of an accredited School of Nursing or Bachelor in Psychology or Social Work or Master of Social Work or related field
- Currently licensed by the State of SC Board of Nursing and/or Board Social Work
- Minimum of two years experience in Utilization Management
- Working knowledge of hospital, JCAHO, CMS and other regulatory bodies
- Knowledge of medical necessity/level of care criteria
- Excellent interpersonal skills to provide orientation to new staff and nurses
- Knowledge of psychotropic medications, behavior management, and bio-psychosocial functioning across the life span
- Sound judgement, initiative, integrity, dependability, and decision-making abilities
- Strong written and verbal English communication skills
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