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Healthcare Utilization Review Specialist
2 months ago
The Utilization Review Coordinator PRN is a key member of the Austin Oaks Hospital Team who is responsible for ensuring that financial benefits are maximized in the treatment and discharge planning for assigned cases through initial and continued stay reviews, prior authorization work for discharge services, effective liaison work and communication between business office and treatment team, support of the discharge plan, and active pursuit of appeals.
Key Responsibilities- Conducts concurrent and extended stay reviews on assigned patients in a reasonable time frame, ensuring the information is presented in a concise, articulate manner.
- Schedules upcoming reviews; notifies the attending physician of physician reviews and facilitates reviews if necessary.
- Establishes a good rapport with third party reviewers while maintaining an advocacy stance on behalf of the client; submits any written materials requested by third party payers in a timely manner.
- Is pro-active and independent in gathering information for reviews from the client record and takes the initiative to seek information from members of the treatment team if necessary.
- Notifies all concerned parties when cases are denied, giving recommendation regarding viability of appeal; effectively coordinates collection of all pertinent data to support organization and patient's position; ensures appeals are prepared within the dictated time constraints.
- Maintains accurate and current records on day's denied and current status of appeals; demonstrates effective written communication skills in formulating appeals.
- Maintains appropriate records of the utilization review data and activities; updates patient accounting database daily with accurate discharge and certification information; ensures files and records are organized and thorough and easily accessible.
- Participates in formulation of patient's treatment and discharge plans with other members of the treatment team.
- Maintains on-going contact with insurance reviewers to maintain certification status by providing reviewing insurance with discharge information including outpatient appointments that the patient has post discharge.
- Supports departmental goals by attending and participating in department meetings and offering ideas and suggestions regarding goals and objectives.
About Universal Health Services
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies.
Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
QUALIFICATIONS :
EDUCATION :
Required: B.A.
Preferred: Masters degree; Social Work, Counseling, or related field.
LICENSURE / CERTIFICATION :
Current CPR; Preferred Licensed Mental Health Professional; LPC, LMSW, LCSW or RN.
EXPERIENCE :
Required: Minimum of two (2) years professional experience in a health care setting, preferably inpatient. Minimum of two (2) years' experience in UR.
Preferred: Five years' experience in mental health in an inpatient facility. Five years UR experience.
