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Utilization Review Coordinator
The Meadows-TN
Wickenburg, AZ
Full-Time
General Purpose of Position:
Develops and implements systems for the authorization, concurrent and retrospective review of inpatient admissions and services. May also be involved with writing and facilitating appeals for denied treatment days.
Primary Responsibilities (include but are not limited to):
- Provide professional and thorough communication with external representatives to obtain authorization for admission and continued stay.
- Monitor each step of the authorization process to proactively identify potential problems and optimize outcome.
- Minimize the number of cases that need to be referred for psychiatric peer/peer review.
- Interact with patient care staff to assure patient assessment and treatment plan is accurately and consistently reflected in facility documentation.
- Prioritize multiple and various types of case activity; coordinate with UM team to ensure all deadlines are met with highest possible quality of delivery.
- Maintain cumulative documentation regarding actions taken during the UR process.
- Conduct reviews to ensure that services and documentation conform to the facility protocols, and the requirements of third party payer sources.
- Same as interact with patient care staff as above
- Attend treatment staffings and other scheduled meetings to obtain and present information on patient status, care and stay.
- Communicate authorization status, issues or problems to appropriate staff/departments.
- Obtain and maintain authorization for each patient. Problem-solve issues relating to stay or service.
- Respond quickly and effectively to requests for information.
- Nurture positive and professional relationships with external (third party payer) sources.
Education, Skills and Experience Requirements:
- Bachelor/Associates Degree in Nursing or related job experience
- Arizona licensure/certification in good standing (RN) CPR Certification optional.
- Prefer a minimum of two years experience in a psychiatric setting or behavioral health utilization review. Knowledge of medical terminology, psychiatric interventions and medications and insurance is essential to this position.
- Ability to use telephones extensively; ability to relay clear written messages; ability to use computer keyboard and calculator extensively.
- Ability to effectively read, write and process information; ability to input/retrieve information to/from computer and files.
- Ability to converse with others to give, take and process information in English; extensive use of telephone. Ability to hear alarms and pages.
- Ability to converse in English with others to give, take and process information; extensive use of telephone. Ability to maintain confidentiality of information, multi-task, coordinate projects and record/transcribe general and specific meeting minutes. Ability to work independently and collaboratively. Communicate with other staff to relay concerns and observations involving patient safety.
- Occasional/limited exposure to: Infection and to the risk of blood borne diseases; hazardous agents, body fluids and wastes; unpleasant patient or departmental elements; to potentially violent/aggressive patients/staff/visitors, critical incidents, and/or sentinel events. Occasionally needed to work irregular hours or additional hours.
- Ability to provide excellent service to internal and external customers.
- Ability to effectively listen, process received information, and express ideas both orally and in writing in English.
- Ability to initiate action, take personal responsibility, suggest improvements, and solve problems within scope of job without being asked
- Ability to understand and comply with government, regulatory, and company rules.
- Ability to record, report, and maintain confidentiality of information and respond to requests for information.
- Ability to get assigned work done in an acceptable manner, in the time allotted, with minimal prompting or reminders
#CB
Recommended skills
Utilization Management
Psychiatry
Behavioral Health
Nursing
Authorization (Medical)
Patient Assessment
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