Utilization Review/Management Coordinator

UHS • Grand Rapids, MI

6d

About The Position

The Utilization Review Coordinator is dedicated to gather and coordinating information regarding patient symptomatology and treatment modalities for the purpose of internal and concurrent reviews with insurance companies.

Requirements

• RN/MA/MSW.
• Professional licensure in the State of Michigan.
• Experience working with psychiatric utilization review criteria.
• Knowledge of psychiatric program delivery and utilization review criteria.

Responsibilities

• Negotiates and advocates on behalf of the patient and the Hospital.
• Assesses and interprets most appropriate level of care based upon patient present level of functioning and responsiveness to treatment interventions. Provides clinical appropriateness data (verbal and written) to outside utilization review agencies and insurance companies according to policy and procedure.
• Review discharges, as assigned. Calculate length of stay and document number of days certified for billing purposes. Report discharges to outside reviews as indicated, including discharge plan and medications.
• Complete continued stay reviews with external review agencies as indicated.
• Complete pre-certifications, as assigned.
• Prioritizes daily workload between various types of reviews and discharges to ensure timely completion.
• Assist with denial/appeals, including maintenance of denial log for assigned cases.
• Provide Utilization Review guidance consultative services to UR department and to all departments when requested. Services include analysis of medical records, data and participation in committees as requested.
• Analyzes patient clinical information to determine patient length of stay and level of care.
• Review all assigned Medicare charts for medical necessity and report findings to treatment team weekly.
• Maintains Utilization Review files and logs in a neat, accurate and orderly form.
• Provides feedback to the Department Manager on the development/modification of the utilization review plan.
• Attends treatment team daily to review assigned cases with team.
• Complete and updates MIDAS reports daily, as assigned.
• Assume Hospital Safety Responsibilities.

Benefits

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plan
• 401(K) with company match and discounted stock plan
• Career development opportunities within UHS and its 300+ Subsidiaries
• Shift differentials are paid for evening, night and weekend shifts

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees