Utilization Review Specialist
3 weeks ago
* Review all patients’ admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures.
* Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria.
* Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services.
* Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices.
* Contacts physicians and primary Nurses for clarification of information as necessary.
* Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies.
* Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested.
* Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated.
* Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues.
* Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings.
* Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups.
* Performs special projects or other related work as required or requested.
* Shows ability to communicate in a clear and concise manner.
The ideal candidate would have the following knowledge at time of hire:
· Knowledge of Medical Records procedures, medical terminology and office practices.
· Knowledge of hospital utilization review policies and processes.
· Ability to use data collection techniques, and statistical computations.
· Ability to communicate effectively and professionally with third party insurance agencies.
· Knowledge of DSM and criteria for meeting diagnoses.
· Thorough knowledge of effective and appropriate charting principles.
*Education: *
Associates degree preferred, min two years’ experience in a mental health setting.
*Experience:*
One (1) year of experience in psychiatric and/or chemical dependency preferred.
Job Type: Full-time
Benefits:
* 401(k)
* Dental insurance
* Employee assistance program
* Flexible spending account
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Day shift
* Monday to Friday
Education:
* High school or equivalent (Required)
Experience:
* Utilization Review: 1 year (Preferred)
* mental health: 1 year (Required)
* detox: 1 year (Required)
* precertification: 1 year (Preferred)
Work Location: In person
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