ECT Coordinator

Trinity Health • Livonia, MI

10d

About The Position

The Utilization Review (UR) Coordinator I colleague is responsible for conducting the utilization review process in accordance with federal and state law, licensure/ accreditation and hospital standards and Third-Party payor requirements. The review process includes but is not limited to admission/re-admission review (includes identification of fragmentation of care, combined admissions), pre-certification/re-certification review, data gathering for identified projects, internal audits, retrospective reviews, statistics, coding, billing or verification issues.

This role also assists with the development of workflow, policies, and procedures to optimize ECT services, ensuring efficiency and effective service delivery. It involves developing training for staff to provide high-quality service delivery between internal and external resources, and working closely with both internal programs/services and external organizations to coordinate patient referrals, ensuring seamless integration of services. The coordinator manages the ECT scheduling and throughput of services, coordinates services with other departments for safe flow, and handles prior authorization, benefits verification, and denial reduction. They partner with billing to review coding/claims issues, assure complete and accurate documentation in the EHR, and onboard/train new colleagues to ECT workflows. The role includes tracking and reporting Key Performance Indicators (KPIs) and preparing for surveys/audits.

Requirements

• Associate’s degree in health-related field or nursing preferred.
• Three years of recent acute care utilization management experience.
• Current RHIT or LPN preferred.
• Understanding of computers and software in order to collect and report information for required data sources.
• Ability to work autonomously with little direction and be accountable for outcomes.
• Excellent customer service orientation skills necessary to deal effectively with various levels of hospital personnel, outside customers and community groups.
• Master’s degree in social work, counseling, bachelor’s-level RN, and/or equivalent license.
• 3+ year in behavioral health, preoperative services, care coordination, or related setting.
• Prior experience with Utilization Review.
• Experience with ECT or other procedural coordination of care preferred.

Nice To Haves

• Associate’s degree in health-related field or nursing
• Current RHIT or LPN
• Experience with ECT or other procedural coordination of care

Responsibilities

• Conducts the utilization review process in accordance with federal and state law, licensure/ accreditation and hospital standards and Third-Party payor requirements.
• Performs admission/re-admission review, pre-certification/re-certification review, data gathering for identified projects, internal audits, retrospective reviews, statistics, coding, billing or verification issues.
• Provides leadership and expertise for utilization management processes.
• Reviews assigned medical records in a timely manner for admission, concurrent or retrospective review using criteria to determine appropriate level of care.
• Documents criteria in the EMR and follows the hospital Utilization Review Plan.
• Demonstrates competency with InterQual application and MCG criteria.
• Analyzes and disseminates appropriate clinical information for payer authorization, communicating succinctly to the 3rd party payer.
• Contacts the internal physician advisor on cases that do not meet established guidelines.
• Obtains further documentation from the physician to support an IP level of care in the event of a denial.
• Manages the DNFB (discharged but not final billed) list and other UR hold reports.
• Develops and shares reports as requested.
• Initiates and coordinates Peer-to-Peer discussions with physician and payer.
• Obtains authorizations as required for reimbursement from appropriate Third-Party Payor.
• Mediates and coordinates process between insurance company and hospital clinical staff when a patient requires transfer to another acute care hospital.
• Processes all technical and administrative denials for all clinical areas of the hospital and facilitates the appeal process.
• Communicates to the payer patient discharge date and discharge plan.
• Mediates between case manager and payer to ensure a seamless transition in care and appropriate post-acute follow-up.
• Provides updated third-party payor information to assigned Case Manager for continuity of care.
• Identifies areas of quality concerns, inappropriate use of resources and any other issues that restrict the implementation of hospital, department objectives and refers findings for appropriate follow-up.
• Reviews IP denials with the appeals nurse to determine appropriate status and reimbursement from payer.
• Assists other departments in the reimbursement process including, but not limited to, changes in inpatient, outpatient and observation status, identification of appropriate surgical status and other interventions needed to reduce patient and hospital liability of financial loss.
• Demonstrates proficiency in using various computer programs required including EPIC and various payer portals.
• Responsible for combining admissions on those cases that are appropriate and communicating to Insurance Verification and Health Information Management.
• Assists with payer-specific audits as assigned, i.e. RAC, HDI.
• Functions as a resource to physician, hospital staff or departments and other ‘customers” of the hospital to assist in complying with the utilization review processes.
• Participates in UR Committee, department staff meetings and ad hoc committees.
• Participates in review and analysis of outcome data related to UR functions and identification of system and process issues that contribute to denials.
• Maintains good rapport and cooperative relationships, and approaches conflict in a constructive manner.
• Helps to identify problems, offer solutions, and participate in their resolution.
• Maintains the confidentiality of information acquired pertaining to patients, physicians, associates, and visitors to Trinity Health.
• Behaves in accordance with the Mission, Vision and Values of Trinity Health.
• Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
• Assists with the development of workflow, policies, and procedures to optimize ECT services, ensuring efficiency and effective service delivery.
• Develop training for staff to provide high-quality service delivery between internal and external resources.
• Works closely with both internal programs/services and external organizations to coordinate patient referrals, ensuring seamless integration of services.
• Coordinates all pre-procedure requirements and obtains documentation to ensure clearance of procedure.
• Manages the ECT scheduling and throughput of services including minimizing unfilled time.
• Coordinates services with other departments to ensure safe flow of service delivery.
• Coordinates prior authorization, benefits verification, and ensures reduction of denials.
• Partner with billing to review coding/claims issues.
• Assures complete, accurate, and timely documentation of clinical information in the EHR, incorporating current documentation and billing guidelines and requirements.
• Onboarding new colleagues to ECT workflows; provide training and education to current colleagues as needed.
• Track and report out all Key Performance Indicators (KPI) timely including time-to-start, cancelations/no-show rates, adverse events, Length of Stay (LOS), recidivism, and utilization.
• Prepare for surveys/audits, as needed.
• Maintains good rapport and cooperative relationships. Approaches conflicts in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
• Maintains the confidentiality of information acquired pertaining to patient, physicians, associates, and visitors to Trinity Health. Discusses patient and hospital information only among appropriate personnel in appropriate private places.
• Behaves in accordance with the Mission, Vision and Values of Trinity Health.
• Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

Benefits

• We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level