Utilization coordinator

Job Description

Responsibilities

Position Purpose : Serves as provider for resident-centered services that promote coordinated, effective treatment by facilitating the communication exchange between referral source, physician / treatment team and payor and managing timely transitions through the phases of residential care.

Responsibilities :

• Facilitates communication regarding resident treatment process and needs with referral sources and payor.
• Keeps accurate records of the authorizations for residents in treatment.
• Ensures coordinated effective resident care including admission, continued stays, and discharge requirements.
• Ensures positive relationships with external and internal customers.
• When appropriate, travels to resident’s community representing the facility at FAPT meetings and court hearings.
• Ensures continued availability (recertification) of financial resources throughout the residents’ stay.
• Develops systems to review and respond to concerns expressed by customers. Together with the appropriate Department head, he / she works to resolve issues to the satisfaction of the customer and facility.
• Review of clinical patient data with third party reviewers to substantiate the need for continued hospital level of care of ongoing participation in treatment programs.
• Communicate and coordinate third party reviewer’s level of care decisions and expectations to appropriate clinical and administrative staff.
• Assist in preparing Utilization Review Reports as necessary.
• Coordinates and makes Retrospective Appeals to third party payers.
• Meets weekly with Administrator on appropriate issues.
• Other duties as assigned based on the needs of the facility.

Qualifications

Qualifications : Skills, Knowledge and Abilities

Needs basic understanding of and comfort level with medical terminology, residential treatment, clinical science / pathology and psychiatric disorders.

Must know how to gather and analyze data. Must be articulate, assertive, and able to communicate effectively with families, payors, therapists and physicians both verbally and in writing.

Must also demonstrate initiative, tact and good judgement. Must be able to acquire clear understanding of treatment priorities and ability to make sound decisions balancing resident and family needs with available resources.

Must have basic computer skills.

Education : A bachelors degree or three years of professional experience working with children.

Physical

Requirements : Must be able to mentally handle stressful and quick changing situations. Must have normal auditory processing.

Must have clear verbal speech with no impediments. % of time, incumbent is seated and talking on the phone or using a computer.

Exposure

Categories : Blood Borne Disease Exposure Category : Category II

Last updated : 2024-05-22