Hiring: Regional Utilization Management Coordinator Company: Oceans Healthcare Location: Lafayette, LA Job Posted Time: 2026-09-13 14:15:43 Employment Type: Remote Target Skills & Keywords : HIPAA, Microsoft Excel, Payer Contracts, Utilization Review About the job Required Skills: •Identifies and reports appropriate use, under-use, over-use and inefficient use of services and resources to ensure high quality patient care is provided in the least restrictive environment and in a cost-effective manner. •Reports findings to appropriate disciplines and/or committees; notifies appropriate staff members of any deficiencies noted so corrective actions can be taken in a timely manner; submits monthly report to UM Director or PI Coordinator of findings and actions recommended to correct identified problems. •Coordinates flow of communication between physicians/staff and third-party payers concerning reimbursement requisites •Attends mini-treatment team and morning status meetings each weekday to obtain third-party payer pre-certification and ongoing certification requirements and to share with those attending any pertinent data from third-party payer contracts. •Conducts reviews via telephone, fax or through payer portals and follows through with documentation requests from third party payers. •Maintains abstract with updates provided to third party payers. •Notifies physicians/staff/patients of reimbursement issues. •Initiates and completes appeals process for reimbursement denials; notifies inpatients of denials received. Qualifications: •Bachelor's degree or higher in social services or related field or licensed nurse. •At least four (4) years utilization management experience in a psychiatric/chemical dependency acute inpatient setting. Compensation: •Flexible work environment (work from home / hybrid options) Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!