Utilization Review Coordinator
Haven Behavioral Healthcare

• Obtain authorization for each admitted patient.
• Review and monitor each step of the authorization process to proactively identify potential problems.
• Interact with physicians and therapists constantly to assure patient assessment and treatment plan is accurately and consistently reflected in facility documentation.
• Track enrollment status continuously to act on changes and initiate retrospective review as necessary.
• Monitor staff communication with external representatives to ensure it is professional and thorough.
• Maintain cumulative documentation regarding actions initiated by staff and self.
• Conduct reviews to ensure that services and documentation conform to the facility protocols, applicable laws and regulations and the requirements of funding sources.
• Collaborate with physicians, nurses, and therapists regarding medical necessity for stay, appropriateness of treatment and estimated length of stay.
• Attend meetings daily to obtain and present information on patient status, care and stay.
• Communicate authorization status, issues or problems to appropriate staff.
• Obtain and maintain authorization for each patient. Problem-solve issues relating to stay or service.
• Respond quickly and effectively to requests for information.
• Nurture positive and professional relationships with external sources.
• Minimize the number of appeals.
• Monitor the authorization for continued stay for each patient, and initiate the appeal process when payment for services is denied due to clinical concerns.
• Coordinate the provision of complete and timely documentation to support the appeal.
• Obtain successful resolution of appeals.

Haven Behavioral Healthcare is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce.