Hiring: Utilization Review Coordinator Company: Oceans Healthcare Location: West Chester, PA Job Posted Time: 2026-09-17 13:15:43 Target Skills & Keywords : 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 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 telephone reviews to, 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: •Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred. •At least one year psychiatric/chemical dependency experience with good working psychiatric/medical knowledge. •Knowledge and in-depth understanding of CD-psych treatment and discharge planning process. •Must demonstrate strong patient advocacy skills. •Must be able to organize and prioritize high volume workload. •Must be able to analyze and utilize data and systems to provide individualized quality treatment in a cost-effective manner. •Must be able to function with minimal supervision. •Therapeutic Intervention De-escalation Education required. •Must possess basic competency in age, disability, and cultural diversity for needs of patients served and ability to relate to patients in a manner sensitive to those needs. •Must successfully complete CPR certification and an Oceans approved behavioral health de-escalation program. 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!