River Vista Behavioral Health
UR COORDINATOR FT – River Vista Behavioral Health
Position Summary Facilitates a continuum of service while promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.
Shift & Salary Shift time: Sunday–Thursday 8:00 am–4:30 pm. RN pay range: $50,000 – $55,000. SW pay range: $37,000 – $42,000.
Responsibilities
Perform timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid, and commercial) to secure authorization for continued treatment.
Function as a key member of the multidisciplinary treatment team to educate and guide on level‑of‑care requirements and payer expectations for patient acuity and appropriate utilization.
Complete quality and timely appeal/denial letters; participate in post‑claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.
Work collectively with hospital operations (social services, business office, intake, nursing) to ensure documentation is aligned with patient conditions.
Contribute to monthly utilization data trends using hospital data tools to report for overall operation.
Facilitate physician reviews with payers as required.
Perform other duties as assigned/required by this position.
Qualifications
Education: Bachelor’s Degree in Nursing, Psychology, or Social Work; Master’s preferred.
Licensure: CA RN license required; license in Social Work, AMFT, or Mental Health Counseling preferred.
Experience: Minimum 3–5 years in an acute inpatient psychiatric setting as a treatment team member and/or utilization management experience.
Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines – DSM‑V.
Effective oral and written communication skills to support patient advocacy and negotiation to ensure quality reviews with payers.
Solid understanding of acute inpatient psychiatric hospital operations, including mental health and substance abuse treatment.
Equal Employment Opportunity It is the policy of the facility to provide equal opportunity in employment to all employees and applicants for employment. No person will be discriminated against in employment based on race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state, or local laws.
Americans With Disabilities Act Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case‑by‑case basis in accordance with applicable law.
Service Excellence
Treat everyone as a guest by making a good first impression, anticipating needs and displaying service recovery skills.
Demonstrate professionalism and excellence by looking professional, being accountable for actions and delivering excellence in our everyday work.
Practice teamwork by participating in decision making and process improvement, communicating effectively and focusing on the problem/issue, not the person.
Seniority level Not Applicable
Employment type Full‑time
Job function Other
Industries Hospitals and Health Care, Mental Health Care
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Position Summary Facilitates a continuum of service while promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.
Shift & Salary Shift time: Sunday–Thursday 8:00 am–4:30 pm. RN pay range: $50,000 – $55,000. SW pay range: $37,000 – $42,000.
Responsibilities
Perform timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid, and commercial) to secure authorization for continued treatment.
Function as a key member of the multidisciplinary treatment team to educate and guide on level‑of‑care requirements and payer expectations for patient acuity and appropriate utilization.
Complete quality and timely appeal/denial letters; participate in post‑claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.
Work collectively with hospital operations (social services, business office, intake, nursing) to ensure documentation is aligned with patient conditions.
Contribute to monthly utilization data trends using hospital data tools to report for overall operation.
Facilitate physician reviews with payers as required.
Perform other duties as assigned/required by this position.
Qualifications
Education: Bachelor’s Degree in Nursing, Psychology, or Social Work; Master’s preferred.
Licensure: CA RN license required; license in Social Work, AMFT, or Mental Health Counseling preferred.
Experience: Minimum 3–5 years in an acute inpatient psychiatric setting as a treatment team member and/or utilization management experience.
Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines – DSM‑V.
Effective oral and written communication skills to support patient advocacy and negotiation to ensure quality reviews with payers.
Solid understanding of acute inpatient psychiatric hospital operations, including mental health and substance abuse treatment.
Equal Employment Opportunity It is the policy of the facility to provide equal opportunity in employment to all employees and applicants for employment. No person will be discriminated against in employment based on race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state, or local laws.
Americans With Disabilities Act Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case‑by‑case basis in accordance with applicable law.
Service Excellence
Treat everyone as a guest by making a good first impression, anticipating needs and displaying service recovery skills.
Demonstrate professionalism and excellence by looking professional, being accountable for actions and delivering excellence in our everyday work.
Practice teamwork by participating in decision making and process improvement, communicating effectively and focusing on the problem/issue, not the person.
Seniority level Not Applicable
Employment type Full‑time
Job function Other
Industries Hospitals and Health Care, Mental Health Care
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