UR CLINICAL MANAGEMENT COORDINATOR (San Marcos, TX)

UR CLINICAL MANAGEMENT COORDINATOR (San Marcos, TX)

12 Mar 2024
Texas, San marcos 00000 San marcos USA

UR CLINICAL MANAGEMENT COORDINATOR (San Marcos, TX)

Vacancy expired!

San Marcos Treatment Center has an excellent career opportunity for an experienced UTILIZATION REVIEW CLINICAL MANAGEMENT COORDINATOR to join our dedicated clinical team.

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You will apply YOUR CLINICAL EXPERIENCE to assist treatment teams in providing the best treatment available within the parameters of service that can be justified as Medically Necessary for each patient.

YOUR GUIDANCE is an invaluable tool to the Treatment Teams and permits you to support more patients treatment than any other position would.

The successful candidate will be able to APPLY OVERSIGHT OF PATIENT CLINICAL CARE to short-term commercial managed care, Medicaid/State Agency and Tricare-funded patients ages 7-18 with psychiatric, neuropsychiatric or neurodevelopmental issues and their families.

Education requirements

Current Professional license in good standing in healthcare field, with preference given to LPC, LCSW, LMFT

Experience requirements

The UR Specialist / Clinical Care Management Coordinator is responsible for developing patient care documentation (MTP/MTPU), tracking certification and continued stays, completing appeals, reducing denials and increasing length of stay through competent clinically-focused reviews and attention to detail.

Qualifications

Professional license in good standing in healthcare field, (prefer LPC, LCSW, LMFT). Demonstrated experience in managing interactions with insurance companies regarding obtaining and maintaining authorizations for treatment. Management of concurrent and retrospective review of open and closed records and related tasks.

Demonstrates understanding of Utilization Review/Utilization Management in Psychiatric programs.

Applicant must have a professional presentation with positive verbal, written and interpersonal skills, computer skills and ability to learn new systems; strong organizational skills and attention to detail.

Must be HIPPA knowledgeable and have the ability to maintain confidentiality of patient, facility and financial information.

Must have capacity to understand and demonstrate appropriate and professional boundaries.

Must have ability to work both independently and as part of a team.

Responsibilities

You will demonstrate an understanding/navigation of criteria utilized by managed care, including the following obligations:

Conduct utilization reviews; complete clinical reports and demonstrate success securing continued coverage/authorization for patients.

Prepares and submits appeals of denials.

Demonstrates an ability to organize and efficiently implement all service as required in the areas of concurrent and retrospective reviews on open and closed cases and responds appropriate and effectively to exceptional and unusual/non-routine occurrences as they arise.

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