Utilization Review Coordinator FT

Responsibilities

The UM Coordinator contacts external case managers / managed care organizations for certification and recertification of insurance benefits throughout the patients stay, and assists the treatment team in understanding the insurance companys requirements for continued stay and discharge planning.

The UM Coordinator is responsible for having a thorough understanding of the patients treatment through communication with the treatment team.

The UM Coordinator advocates for the patients access to services during treatment team meetings and through individual physician contact.

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 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 UR 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

1. Review assessment information.

2. 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.

3. Provide feedback to the attending physician and treatment team members concerning continuing certification of days / services.

4. Communicate with external reviewers and referral sources. Conduct external reviews and maintain documentation of interactions.

5.Ensure that third-party payers are notified of, or participate in, decisions about transitions between levels of care.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at : or .

Qualifications

Experience :

A minimum of two (2) years experience in a healthcare setting or managed care company, preferred Hospital experience. Bachelors degree with Masters preferred.