Springwoods Behavioral Health is an UHS affiliated 80-bed acute care behavioral health facility located in Northwest Arkansas and has been providing quality health care to the residents Northwest Arkansas since 2009.  The hospital provides 24-hour acute care behavioral health services. 

Springwoods Behavioral Health is seeking a dynamic and talented Utilization Review Coordinator.

Job Description

The Case Manager coordinates the design, development, implementation, and monitoring of Springwoods Behavioral Health’s case management and utilization review functions.  The Case Manager will achieve the goals of clinical, financial and utilization as set forth in the UR plan by effective management and communication.  The Case Manager functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review.  The Case Manager is responsible for carrying out assignments in a manner to assure success in financial management, quality and operational management objectives.  The Case Manager participates in program development and unit performance improvement.  The Case Manager consistently demonstrates the core values and mission statement of Springwoods Behavioral Health.

 

 Essential Job Duties:

• Completes daily reviews on all patients and oversees the completion of those reviews to all requesting insurance companies per contract agreement.
• Receives all denials for care involving patient stays, discusses with medical team feasibility to appeal.  Manages all appeals related to denials of patient stays for all payors/insurance companies.
• Participates in quality improvement processes and assures implementation of regulatory standards.
• Ensures service is provided considering the age-specific physiological, emotional and cognitive needs of the patients served.
• Acts as a liaison between the patient/family, physician and patient care team as necessary to problem solve.
• Guides staff in the adherence to applicable standards of care/practice and/or departmental/organization expectations.
• Establishes, evaluates, and monitors case management processes, policies and procedures to ensure that appropriate Hospital resource utilization is achieved.
• Serves as an internal resource and consultant to management, medical staff about case management, reimbursement, clinical resource utilization and care coordination issues.