Utilization Review Coordinator

Job Description

Responsibilities

Harbor Point Behavioral Health Center offers hope and healing for youth ages 7 to at the time of admission with several psychiatric diagnoses and/or developmental disabilities. Located in Portsmouth, VA, Harbor Point provides intensive, residential treatment to youth in a comfortable setting that is conducive to healing. Our facility specializes in treating children and adolescents with depression, bipolar, ADHD, and other mental health issues. We also have specific treatment programs for those with intellectual disabilities or those with self-injurious behavior. Harbor Point and its programs are fully accredited by The Joint Commission and the Virginia Association of Independent Specialized Educational Facilities. We are licensed by The Virginia Department of Behavioral Health and Developmental Services and the Virginia Department of Education. We are a TRICARE®-approved and certified facility.

Position Scope :

To provide ongoing support and enhance the quality of resident care, to promote continuity of care and cost effectiveness through the integrating and function of case management, utilization review and discharge planning.

Essential Functions :

• Facilitates communication regarding resident treatment process and needs with referral sources such as DSS and FAPT teams and payers.
• Ensures coordinated, effective resident care including admission, continued stays, and discharge requirements.
• Ensures positive relationships with external and internal customers.
• Ensures continued availability (recertification) of financial resources throughout the residents’ stay.
• Service Excellence.

Qualifications :

Needs basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders. Must know how to gather and analyze data. Must be articulate, assertive, and able to communicate effectively with families, payers, therapists and physicians both verbally and in writing. Must also demonstrate initiative, tact and good judgment. Must be able to acquire clear understanding of treatment priorities and ability to make sound decisions balancing resident and family needs with available resources. Must have basic computer skills. An individual must be able to perform each essential function of the job satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities, who are otherwise qualified, to perform the essential functions.

Qualifications

Education:

Prefer a Bachelor’s Degree in social work, psychology or counseling with documented field work experience.

Experience:

Requires minimum four years’ experience in nursing, rehabilitative services, mental health counseling, or admissions. Prefers minimum two years of Utilization Review/Management, Quality Assurance or Risk Management. Knowledge of DMAS regulations and experience in Acentra/Kepro and Humana/Tricare portal is highly preferable.