Hybrid Utilization Review
2 months ago
JOIN OUR TEAM AS A UTILIZATION REVIEW (UR) COORDINATOR
**Your Work Matters** **_How will you make a difference? _
The UR Coordinator is responsible for contacts external case managers/managed care organizations for certification and recertification of insurance benefits throughout the patient’s stay, and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. The UR Coordinator is responsible for having a thorough understanding of the patient’s treatment through communication with the treatment team. The UR Coordinator advocates for the patient’s access to services during treatment team meetings and through individual physician contact. The UR Coordinator chairs treatment team meetings and continued stay reviews as indicated.
**_Case Management/Utilization Management_**
- Review the treatment plan and advocate for additional services as indicated.
- Promote effective use of resources for patients.
- Ensure that patient rights are upheld.
- Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the team.
- Collaborate with the treatment team regarding continued stay and discharge planning issues.
- Advocate that the patient is placed in the appropriate level of care and program.
- Interface with program staff to facilitate a smooth transition at the time of transfer or discharge.
- Maintain documentation related to case management activities.
- Assure tracking of insurance reviews, and that reviews are completed in a timely manner.
- Maintain statistical reports and prepare documentation of significant findings.
- Communicate insurance requirements to all levels of staff.
- Provide timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews, and discharges.
- Update the denial log statistics on an ongoing basis (at least weekly), and initiate appeals through telephone or written communication within 7 to 10 days of denial.
- Consult with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete.
- Provide clinical information to managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days.
- Coordinate with the insurance company doctor in appeals process and denials process.
**_ Treatment Planning_**
- Review assessment information.
- Attend and chair and coordinate treatment team continued stay reviews, as indicated.
- Communicate with attending physician and program managers, and other providers of service, to assure continuity of care, efficiency, and effective transitions between levels of care.
- Provide feedback to the attending physician and treatment team members concerning continuing certification of days/services.
- Communicate with external reviewers and referral sources. Conduct external reviews and maintain documentation of interactions.
- Ensure that third-party payers are notified of, or participate in, decisions about transitions between levels of care.
**_Discharge Planning_**
- Coordinate discharge plans with the patient/family/significant/other, when indicated.
- Ensure discharge appointments are made in keeping with insurance requirements.
**Your Experience Matters**_ What we’re looking for:_
- **_ Education & Licensure (if applicable): _**Bachelor’s degree in nursing or Master’s degree from an accredited college or university in social work, mental health or related degree required.
- **_ Experience: _**A minimum of two (2) years experience in a behavioral healthcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management.
**Your Care Matters** **_What we provide for our team:_
- 401(k) + matching
- Health insurance
- ** 100% company-paid life insurance coverage up to 2x your annual salary**:
- Vision insurance
- Dental insurance
- ** 100% company-paid long term disability insurance**:
- Paid time off
- Paid holidays
- Cafeteria on site + **discounted meals**:
- Employee engagement events
- Employee assistance program
- Employee recognition program
- Free parking
**What sets us apart?**
- Career & training development opportunities
- Dynamic and inclusive work environment
- Engaged management team dedicated to your success
- A guiding mission and set of values that serve as both our north star and yours, anchoring our collective purpose and aspirations
**Compensation**:
**Get to know us** **_Outstanding Care, Compassionate People, Unparalleled Service_
Discover a fulfilling career at **Hospital for Behavioral Medicine** (HBM)
Welcome to the heart of mental health treatment innovation in Worcester, MA HBM, a cutting-edge 120-bed inpatient facility, is the leading provider of exceptional therapeutic care, prioritizing patient comfort and safety. In pr
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