Utilization Management Coordinator - Willow Grove

PROGRESSIONS INC•Upper Moreland Township, PA

About The Position

Malvern Treatment Centers is currently seeking a full time Utilization Management Coordinator for our Willow Grove Location! This position is a full time, benefit eligible position! Position Summary: To conduct continued stay reviews of medical record documentation using pre-established criteria and to provide updated progress reports to third party payers in order to receive certification for payment. This individual will perform all assigned utilization reviews for residential drug and alcohol clients at our WG & KR sites (based out of WG location) Summary of Essential Position Functions: Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized and authorization numbers. Coordinates reviews, appeals and maintains denial logs. Performs concurrent continued stay reviews using pre-established criteria. Understands Medical Necessity and ASAM criteria and communicates this information accurately to insurance carriers. Consults with appropriate treatment team members for clarification of documentation as needed. Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals. Inputs data accurately for financial purposes. Maintains accurate documentation of all reviews performed. Assists manager and departments in identifying patterns of mis-utilization. Responds to telephone messages quickly, professionally and appropriately. Participates in continuing education to reach professional growth objectives, including maintenance of own credentials, certifications and participating in committees. Attends case conference for clinical updates as needed. Maintains and communicates authorization information to all team members. Monitors/flags charts for high quality documentation prior to completing reviews. Educates new staff members about Medical Necessity criteria, high-quality documentation and insurance needs. Develops and maintains professional relationships and rapport with payers and third party insurance reviewers Other Duties as assigned Supervisory Responsibilities: Not Applicable

Requirements

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily.
This position requires individuals that are client focused; team oriented; great interpersonal and communication skills; flexible to sudden changes in workload, emergency or staffing; dependable; problem solving skills; focused on compliance and performance quality.
Master's Degree preferred, Bachelor’s Degree required and 1 year of direct drug & alcohol experience.
Microsoft office and billing experience preferred.
Requires much independent action and decision making and ability to organize own work.
Knowledge of facility systems and organization as they pertain to medical records and organization review.
Knowledge of medical terminology, medical record format and content.
Risk of exposure to communicable disease.
Possible exposure to intoxicated, disruptive, and/or agitated patients.
Protected from weather conditions.
Sedentary work primarily – lifting 10 lbs. maximum

Nice To Haves

Previous utilization review experience preferred.

Responsibilities

Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized and authorization numbers.
Coordinates reviews, appeals and maintains denial logs.
Performs concurrent continued stay reviews using pre-established criteria. Understands Medical Necessity and ASAM criteria and communicates this information accurately to insurance carriers.
Consults with appropriate treatment team members for clarification of documentation as needed.
Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals. Inputs data accurately for financial purposes.
Maintains accurate documentation of all reviews performed.
Assists manager and departments in identifying patterns of mis-utilization.
Responds to telephone messages quickly, professionally and appropriately.
Participates in continuing education to reach professional growth objectives, including maintenance of own credentials, certifications and participating in committees. Attends case conference for clinical updates as needed.
Maintains and communicates authorization information to all team members.
Monitors/flags charts for high quality documentation prior to completing reviews.
Educates new staff members about Medical Necessity criteria, high-quality documentation and insurance needs.
Develops and maintains professional relationships and rapport with payers and third party insurance reviewers
Other Duties as assigned