Utilization Management Coordinator (Onsite)

Hendricks Behavioral Hospital•Plainfield, IN

3d•$47,000 - $56,000•Onsite

About The Position

The UM 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 UM Coordinator is responsible for having a thorough understanding of the patient’s treatment through communication with the treatment team. The UM Coordinator advocates for the patient’s access to services during treatment team meetings and through individual physician contact. The UM 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. 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. Discharge Planning Coordinate discharge plans with the patient/family/significant/other, when indicated. Ensure discharge appointments are made in keeping with insurance requirements.

Requirements

Bachelor’s or master’s degree from an accredited college or university in social work, mental health, nursing, or related degree preferred
A minimum of two (2) years' experience in a healthcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management

Responsibilities

contacts external case managers/managed care organizations for certification and recertification of insurance benefits
assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning
advocates for the patient’s access to services during treatment team meetings and through individual physician contact
chairs treatment team meetings and continued stay reviews as indicated
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
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
Coordinate discharge plans with the patient/family/significant/other, when indicated
Ensure discharge appointments are made in keeping with insurance requirements