Job description

Midlands Behavioral Health Hospital is South Carolina’s newest, state of the art, acute psychiatric hospital and we are almost ready to open!

Join our team and help us to become the premiere provider of behavioral health services in the state!

POSITION SUMMARY:
The Utilization Review Specialist is responsible for ensuring the necessity and appropriateness of care, effective benefit management and coordination, as well as positive communications and relationship building activities with all customers.

DUTIES RESPONSIBILITIES:

• Maintains significant contact with referring healthcare professional associations, nursing service personnel, medical staff, patients, families, insurance representatives, and other staff.
• Performs insurance verification and ongoing status of payment. Assists hospital business office with matters related to insurance reimbursement.
• Completes cost/benefit analysis of treatment plans and negotiates appropriate rates.
• Coordinates and communicates with all clinical professionals involved with patients.
• Conducts himself/herself in a professional manner in compliance with unit and hospital policies.
• Assists the billing department in appealing denials through the payer’s appeal process.
• Understands the language of contracts and negotiates and/or renegotiates their terms, as necessary.
• Determines alternative care options, performs cost-benefit analyses, and develops a treatment plan that effectively addresses the patient’s needs.
• Monitors the patient’s clinical progress as well as that of the treatment plan.
• Works with the marketing team on inquiries and/or referrals, as requested.
• Collaborates with the attending physician and treatment team to facilitate patient conferences which develop, monitor and refine the treatment plan to achieve identified patient outcomes.
• Facilitates effective team communication regarding new patients’ special needs and preliminary disposition plans.
• Maintains daily contact with nursing units to identify patient needs related to diagnosis, treatment, prognosis, and projected date of discharge.
• Works with physician and treatment team to review orders regarding consults, DME, and discharge plans to ensure compliance with the patient’s insurance company.
• Maintains internal tracking documents and spreadsheets on a daily basis and/or as instructed.

QUALIFICATIONS REQUIREMENTS:

• An Associate’s or Bachelor’s degree in a medical or health-related field healthcare related field is preferred. However, an extensive background in medical billing or health care quality assurance will be considered
• Must have previous experience in medical utilization review
• Must have a reliable source of transportation

BENEFITS:
All of our employees are valued and receive a competitive hourly rate; full time team members are also offered a comprehensive benefit package which includes:

• Medical, Dental, Vision, Life and Disability Insurance/ Flexible Spending Accounts
• Tuition Reimbursement Nursing Loan Repayment Programs
• 401(k)
• Paid Time Off
• New Pet Insurance Discount available
• DailyPay option available! – Get your pay, when you need it.
• Purchasing Power - online purchase/payroll deduction
• Tickets at Work - entertainment ticket discounts
• Employee Assistance Plan - easy-to-use services to help with everyday challenges of life (available for all employees and their families)
• Helping Friends Foundation - our employees’ hardship/crisis fund
• Farmers GroupSelect Auto and Home Insurance - employee discount available – payroll deduction!
• In-facility education programs and more!

Midlands Behavioral Health Hospital is a brand new, state of the art, 64 bed acute psychiatric hospital located in Sumter, South Carolina. We believe in helping people regain their life and live it to the fullest!

We are located at 3180 Broad Street, Sumter, SC 29180 – visit us online at www.midlandsbehavioralhealth.com

Equal Opportunity Employer. Drug Free Smoke Free Workplace. M/F/Vets/Disabled

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