Coordinator – Utilization Management

Full Time - UM Coordinator

Knoxville Center for Behavioral Medicine - a comprehensive inpatient behavioral health facility.

Our center will provide acute behavioral health care and outpatient treatment to adults and geriatric adults who are in crisis from severe symptoms related to behavioral health and/or substance use disorder.

DEPARTMENT: Utilization Management REPORTS TO: UM Manager

GENERAL DESCRIPTION: Provide administrative support to the Utilization department.

MINIMUM EDUCATION/EXPERIENCE/SKILLS:



* High school diploma required with 2 years of experience in the Behavioral Health Field.

Bachelor's Degree in nursing or Other Clinical degree preferred

ESSENTIAL FUNCTIONS: Are determined by the facility and may include, but are not limited to the following:

Perform pre-certification and negotiate continued stay with third party payers in a professional manner.

Gather data to support case management activities, including presentation of gathered data and case notes.

Verbally present knowledge of cases and the needs of third party payers in a timely manner.

Assist in admissions review, concurrent reviews and discharge planning.

Assist physician in peer review by serving as information resource, gathering data to support review and schedule peer review.

Keep leadership advised of status of current person(s) receiving services, in regard to utilization activities through timely documentation and participate in performance improvement activities.

Coordinate with clinical team for discharge planning, maintain CRM database with discharge information and follow up.

OTHER FUNCTIONS:

Performs other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

High school diploma or equivalent required.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Current certification as Registered Addiction Specialist, certified Substance Abuse Counselor or similar certification preferred.

ADDITIONAL REGULATORY REQUIREMENTS:

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g.

emergencies, changes in workload, rush jobs or technological developments) dictate.

Communication:


* Uses language that is easily understood and appropriate for the specific situation.