This position is eligible to receive a sign-on bonus of $4,000 for a one-year commitment. Please apply and / or contact Human Resources for details.
The Utilization Review Coordinator is responsible for ensuring that financial benefits are maximized in the treatment and discharge planning for assigned cases through initial and continued stay reviews, prior authorization work for discharge services, effective liaison work and communication between business office and treatment team, support of the discharge plan, and active pursuit of appeals.
Additionally, the Utilization Review Coordinator :
Conducts concurrent and extended stay reviews on assigned patients in a reasonable time frame, ensuring the information is presented in a concise, articulate manner.
Schedules upcoming reviews; notifies the attending physician of physician reviews and facilitates reviews if necessary.
Establishes a good rapport with third party reviewers while maintaining an advocacy stance on behalf of the client; submits any written materials requested by third party payers in a timely manner.
Is pro-active and independent in gathering information for reviews from the client record and takes the initiative to seek information from members of the treatment team if necessary.
Notifies all concerned parties when cases are denied, giving recommendation regarding viability of appeal; effectively coordinates collection of all pertinent data to support organization and patient’s position;
ensures appeals are prepared within the dictated time constraints.
Maintains accurate and current records on day’s denied and current status of appeals; demonstrates effective written communication skills in formulating appeals.
Maintains appropriate records of the utilization review data and activities; updates patient accounting database daily with accurate discharge and certification information;
ensures files and records are organized and thorough and easily accessible.
Participates in formulation of patient’s treatment and discharge plans with other members of the treatment team.
Maintains on-going contact with insurance reviewers to maintain certification status by providing reviewing insurance with discharge information including outpatient appointments that the patient has post discharge.
Supports departmental goals by attending and participating in department meetings and offering ideas and suggestions regarding goals and objectives.
Performs other duties as assigned.
EDUCATION & EXPERIENCE
Master’s degree in a clinical field such as Social Work, Psychology, Human Services, or other related field.
KNOWLEDGE & SKILLS
The candidate should be able to perform assignments with minimal supervision; work successfully under highly stressful conditions;
make sound, independent judgments based on scientific and / or ethical principles; ability to adapt to varying workloads and work assignments;
maintain effective comprehensive reading, writing, and communication skills; and have a working knowledge of computers.
MINIMUM REQUIREMENTS OF THE POSITION
Must be willing and able to execute the patient de-escalation methods, both verbal and physical; be able to complete new hire requirements such as State of Alaska Background Check and Drug Testing;
be able to demonstrate special training, knowledge and skills specific to age groups, as well as job and / or program specific competency within three (3) months of hire date;
be certified in CPR and Handle with Care Training upon completion of orientation and annually thereafter; complete all mandatory in-
services annually; be tested for Tuberculosis with a PPD skin test annually or by a chest x-ray annually.
GENERAL WORKING ENVIRONMENT
Working conditions for all employees are as follows, but not limited to a psychiatric hospital setting; some risk involved in the event of aggressive patient(s);
work load may include day, evening, night, weekend and / or holiday shifts. Employees occasionally exposed to blood borne pathogens, and loud noise levels.
Mental demands described herein are representative of those which must be met by an employee to successfully perform the essential functions of the job, but are not limited to the ability to remain calm in a stressful environment;
and the emotional stability, physical stamina and agility to handle stress and respond quickly and effectively to emergency situations.
Requirements include, but are not limited to the ability to communicate effectively with employees; the ability to effectively utilize communication equipment;
the physical agility to manage cleaning equipment; the ability to read, write.
Frequently utilize physical ability for standing or sitting for long periods of time.
Regularly utilize physical ability for speaking, hearing, and seeing with correction for close and distance vision, color discrimination, peripheral vision, depth perception and focusing ability.
Speaking and hearing may be necessary for conversing with and assessing employees.
Able to ascend / descend stairs and ramps; body agility is emphasized.
Able to bend body downward and forward by bending spine at the waist; bend legs at knee to come to a rest on knee(s)
Able to extend hands and arms in any direction
Able to use upper and lower extremities to exert force in a pulling or pushing motion. Exerting up to 50 pounds of force occasionally, and / or up to 20 pounds of force frequently, and / or up to 10 pounds of force constantly to move objects
Able to raise objects from a lower to higher position or from side-to-side.
The worker is subject to both environmental conditions : Activities occur inside and outside.
The worker is subject to hazards : Includes a variety of physical conditions
Must be able to concentrate amidst distractions; must be able to perform work of a repetitive nature; must respond calmly to potentially volatile clients
Mental demands include but are not limited to emotional stability, physical stamina and agility to handle stress and respond quickly and effectively to emergency situations.