Utilization Review/Management Coordinator
Universal Health Services, Eastmont, WA, United States
Benefit Highlights
Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
Shift differentials are paid for evening, night and weekend shifts
Position Summary
The Utilization Review Coordinator is dedicated to gathering and coordinating information regarding patient symptomatology and treatment modalities for the purpose of internal and concurrent reviews with insurance companies.
Essential Job Functions and Responsibilities
Negotiates and advocates on behalf of the patient and the Hospital.
Assesses and interprets most appropriate level of care based upon patient present level of functioning and responsiveness to treatment interventions. Provides clinical appropriateness data (verbal and written) to outside utilization review agencies and insurance companies according to policy and procedure.
Review discharges, as assigned. Calculate length of stay and document number of days certified for billing purposes. Report discharges to outside reviews as indicated, including discharge plan and medications.
Complete continued stay reviews with external review agencies as indicated.
Complete pre-certifications, as assigned.
Prioritizes daily workload between various types of reviews and discharges to ensure timely completion.
Assist with denial/appeals, including maintenance of denial log for assigned cases.
Provide Utilization Review guidance consultative services to UR department and to all departments when requested. Services include analysis of medical records, data and participation in committees as requested.
Analyzes patient clinical information to determine patient length of stay and level of care.
Review all assigned Medicare charts for medical necessity and report findings to treatment team weekly.
Maintains Utilization Review files and logs in a neat, accurate and orderly form.
Provides feedback to the Department Manager on the development/modification of the utilization review plan.
Attends treatment team daily to review assigned cases with team.
Complete and update MIDAS reports daily, as assigned.
Assume Hospital Safety Responsibilities.
Minimum Skills, Experience, Licensure and Educational Requirements
RN/MA/MSW.
Professional licensure in the State of Michigan.
Experience working with psychiatric utilization review criteria.
Knowledge of psychiatric program delivery and utilization review criteria.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to 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.
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Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
Shift differentials are paid for evening, night and weekend shifts
Position Summary
The Utilization Review Coordinator is dedicated to gathering and coordinating information regarding patient symptomatology and treatment modalities for the purpose of internal and concurrent reviews with insurance companies.
Essential Job Functions and Responsibilities
Negotiates and advocates on behalf of the patient and the Hospital.
Assesses and interprets most appropriate level of care based upon patient present level of functioning and responsiveness to treatment interventions. Provides clinical appropriateness data (verbal and written) to outside utilization review agencies and insurance companies according to policy and procedure.
Review discharges, as assigned. Calculate length of stay and document number of days certified for billing purposes. Report discharges to outside reviews as indicated, including discharge plan and medications.
Complete continued stay reviews with external review agencies as indicated.
Complete pre-certifications, as assigned.
Prioritizes daily workload between various types of reviews and discharges to ensure timely completion.
Assist with denial/appeals, including maintenance of denial log for assigned cases.
Provide Utilization Review guidance consultative services to UR department and to all departments when requested. Services include analysis of medical records, data and participation in committees as requested.
Analyzes patient clinical information to determine patient length of stay and level of care.
Review all assigned Medicare charts for medical necessity and report findings to treatment team weekly.
Maintains Utilization Review files and logs in a neat, accurate and orderly form.
Provides feedback to the Department Manager on the development/modification of the utilization review plan.
Attends treatment team daily to review assigned cases with team.
Complete and update MIDAS reports daily, as assigned.
Assume Hospital Safety Responsibilities.
Minimum Skills, Experience, Licensure and Educational Requirements
RN/MA/MSW.
Professional licensure in the State of Michigan.
Experience working with psychiatric utilization review criteria.
Knowledge of psychiatric program delivery and utilization review criteria.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to 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.
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