Utilization Review Coordinator

PROGRESSIONS INC•Philadelphia, PA

7h•Onsite

About The Position

Malvern Behavioral Health is currently seeking a full time Utilization Management Coordinator for our new Acute Inpatient units located at 3905 W. Ford Road, Philadelphia, PA 19131! 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 utilization reviews for acute psychiatric and residential drug and alcohol clients.

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 or graduate of an accredited nursing program with licensure in the state of Pennsylvania.
Knowledge of medical terminology, medical record format and content.

Nice To Haves

Previous utilization review experience preferred.
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.

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 review sheets of all reviews performed.
Assists supervisor 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. Attendance at case conference for clinical updates.
Maintains and communicates authorization information to all team members.
Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required.
Educates new staff members about Medical Necessity criteria, high-quality documentation and insurance needs.
Develops relationship and rapport with payers and third party insurance reviewers
Initiates and follows the precertification and/or single case agreement process as necessary.