Utilization Management Coordinator - Philadelphia

Malvern Treatment Centers is currently seeking a full time Utilization Management Coordinator for our location in Philadelphia! This position is a full time, benefit eligible position and reports to our brand new location at 3905 W. Ford Road Philadelphia, PA 19131.

Position Summary: To conduct continued stay reviews of medical record documentation using pre-established criteria and to provide updated progress reports to third party payers in order to receive certification for payment. This individual will perform all utilization reviews for acute psychiatric and residential drug and alcohol clients.

Summary of Essential Position Functions:

Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized and authorization numbers.

Coordinates reviews, appeals and maintains denial logs.

Performs concurrent continued stay reviews using pre-established criteria. Understands ASAM criteria and communicates this information accurately to insurance carriers.

Consults with appropriate treatment team members for clarification of documentation as needed.

Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals. Inputs data accurately for financial purposes.

Maintains accurate review sheets of all reviews performed.

Assists supervisor and departments in identifying patterns of mis-utilization.

Responds to telephone messages quickly, professionally and appropriately.

Participates in continuing education to reach professional growth objectives, including maintenance of own credentials, certifications and participating in committees. Attendance at case conference for clinical updates.

Maintains and communicates authorization information to all team members.

Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required.

Educates new staff members about ASAM criteria, high-quality documentation and insurance needs.

Develops relationship and rapport with payers and third party insurance reviewers

Benefits

This position is a full time, benefit eligible position. Benefits offered include, but not limited to:

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life Insurance

• Paid Time Off

• 401K plan with company match