UR Coordinator

Clive Behavioral Health

Clive Behavioral Health is a 100-inpatient bed stand-alone mental health hospital. We provide compassionate inpatient and outpatient care for individuals of all ages who struggle with a behavioral health disorder or co-occurring disorders. Our care providers work closely with patients and their loved ones to help achieve their personal treatment goals. We provide a secure, healing environment for all our patients, staff and visitors. We also offer intensive outpatient programming (IOP) for adolescents aged 13 to 17 and a substance use disorder intensive outpatient program for adults called First Step Recovery. Our goal with all of our programs is to help people reach their highest quality of life.

UR Coordinator Position Summary

The UR Coordinator is responsible for collaborating with healthcare providers, clinical staff, and patients to promote quality of care outcomes, and the effective use of resources. This position evaluates the appropriate utilization of services, including identifying potential overutilization and underutilization. The UR Coordinator interprets health plans and medical records in accordance with current standards of care and ensures compliance with Managed Care Organization (MCO) requirements, credentialing standards, and other applicable regulatory requirements. This position is on-site with full-time working hours Monday - Friday.

Key Responsibilities

• Screen the appropriateness of admissions and continued stays based on medical necessity.
• Collaborate and communicate with the treatment teams, external review organizations and Managed Care Organizations.
• Assess utilization of services and identify for potential overutilization and underutilization.
• Review health plans and medical records to support appropriate levels of care.
• Assist with and supervise discharge planning activities.
• Manage denials and appeals.
• Promote quality of care outcomes while supporting appropriate and cost-effective resource utilization.
• Maintain compliance with applicable MCO, CMS, TJC and other regulatory and quality standards.
• Perform other duties related to utilization management and care coordination as assigned.

Work Environment

This is an on-site, full-time position. Schedule is Monday - Friday. This position requires sitting in front of a computer for extended periods of time.

Qualifications

Education: Bachelor's degree in nursing or psychology from an accredited college or university preferred.

Experience: Minimum of 2-3 years of direct clinical experience required. Experience in a psychiatric or mental health setting strongly preferred. Experience with: Patient assessment and treatment planning. CMS quality improvement guidelines. Medicare and Medicaid. Communication with external review organizations. Utilization management, utilization review.

Knowledge of InterQual and/or MCG criteria strongly preferred. Familiarity with NCQA and/or URAC standards preferred.

Licensure & Certifications: Professional licensure is not required but highly preferred. Additional certifications related to case management, mental health, utilization management, and/or quality improvement are highly valued. Candidates without professional license must have equivalent experience in Utilization Management.

Ideal Candidate

The ideal candidate is a clinical knowledgeable and detail-oriented professional who can effectively evaluate medical necessity, coordinate with multidisciplinary teams, navigate managed care requirements, and advocate for appropriate patient care while ensuring regulatory and quality standards are met.

What do our current nurses value at UHS?

An environment that puts patient care first. Having the opportunity to grow, learn, and advance in your career. Supportive and responsive leadership. Competitive salary and comprehensive benefits package.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Universal Health Services