What are the responsibilities and job description for the Utilization Review Coordinator-PRN position at UHS?
Responsibilities
BASIC FUNCTION:
Responsible for managing all utilization case management activities for assigned cases from admission through discharge to final disposition of case, including appeals in accordance with hospital Utilization Review Plan for patient population from ages 11+. Provides support to Program and treatment team in focus and documentation of medical necessity and timely discharge planning. Maintains data on UCM activities and generates required reports, logs, and files as requested. Internally, the incumbent will interface with hospital management, staff, and patients. Externally, the incumbent will interface with licensing and accrediting agencies, managed care companies, family members, and healthcare treatment agencies.
CORE COMPETENCIES:
- Ability to monitor and evaluate records for quality and appropriateness of care.
- Ability to present the case for patient’s need for hospital treatment to the review company representative in a convincing and assertive manner.
- Ability to problem solve in a team manner and take initiative to be a self-starter.
- Ability to analyze and compile data from patient records in a timely and accurate manner.
- Ability to obtain additional information, as needed, from various clinicians to support authorization requests.
- Ability and interest in teaching staff how to document medical necessity and good treatment planning.
- Knowledge of and ability to work well within hospital systems and maintain confidentiality.
- Excellent communication and organization skills.
- Ability to work collegially and creatively with all clinical and administrative staff under the supervision of the Director of Utilization Case Management.
- Commitment to the hospital’s goal of providing quality patient care and respect for the hospital’s efforts toward providing that care.
- Knowledge of JCAHO and Medicare Utilization review standards.
- Awareness of hospital legal responsibilities.
- Ability to develop rapport with reviewers and high tolerance for frustration.
- Ability to adjust work flow and pace depending on daily caseload.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Tracks new admissions or transfers to assigned area and is responsible for knowing and following through with certification requirements from admission through discharge. Serves as liaison to on-site external reviewers.
- Uses Midas for recording reviews and tracking denials. Adds to Midas databases as needed.
- Teaches staff to document medical necessity through in-services or individual meetings. Monitors quality of records and notifies staff and program director of problems. Available to program director to develop plan for improvement as needed.
- Supports and guides treatment planning as needed. Continues to bring to staff awareness the need for documentation to flow from and correlate with treatment plan.
- Informs department director of changes in managed care companies. Maintains awareness of unique status to propose out of plan benefits or to open the door to increase hospital’s opportunity to provide services to a larger group.
- Works appropriately and professionally with all staff and demonstrates a supportive attitude toward the goals of the hospital. Makes recommendations for the hospital based on identified trends.
- Arranges schedule in consideration of needs of the department, participates in arranging coverage for planned absences and demonstrates a supportive attitude toward the goals of the department.
- Performs other job related duties as assigned.
SUPERVISORY RESPONSIBILITIES:
None.
Qualifications
MINIMUM REQUIREMENTS:
- Bachelor’s degree in applicable field of study required OR equivalent combination of education and experience.
- Six months psychiatric utilization review either for hospital or external review organization preferred.
Salary : $0
