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Utilization Review Coordinator (RN or MSW)
Job
Cumberland Hall Hospital
Hopkinsville, KY (In Person)
$80,225 Salary, Full-Time
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Job Description
Utilization Review Coordinator Opportunity Cumberland Hall Hospital is a 97 bed, licensed, acute psychiatric hospital located in beautiful Hopkinsville, KY. Cumberland Hall features individual units for youth, adults and active-duty military, and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average, over 1500 patients receive care from our compassionate health care team each year at Cumberland Hall Hospital.
Website:
https://cumberlandhallhospital.com/ The Utilization Review Coordinator is responsible for evaluating and coordinating patient care services to ensure medical necessity, appropriate level of care, and compliance with insurance and regulatory requirements. This role works closely with clinical staff, physicians, and insurance providers to obtain authorizations, support reimbursement, minimize denials, and promote efficient utilization of hospital resources while maintaining quality patient care.Job Duties to include:
- Review admissions and continued stays for medical necessity.
- Obtain and maintain insurance authorizations and approvals.
- Communicate with payers regarding clinical information and coverage.
- Monitor authorization status and help prevent reimbursement denials.
- Coordinate with treatment teams on level-of-care decisions.
- Maintain accurate utilization review and authorization records.
- Assist with denial management, appeals, and peer reviews.
- Ensure compliance with payer, regulatory, and hospital requirements.