Utilization Reviewer - New Castle, United States - State of Delaware

State of Delaware

Verified Company

New Castle, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Introduction:

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today.

DHSS is a great place to kick-start your profession.

Summary Statement:

This position reports to the Hospital Director, they monitor charts, ensure compliance with federal, state and licensing agencies. Communicates with department heads to ensure the identification of inappropriate allocations of hospital resources and initiates corrective actions. The position also interacts with external reviewers concerning documentation of treatment services rendered, levels of care and verification

Essential Functions:

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class.

Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.

Examines patient charts to analyze the appropriateness and clinical necessity of admissions, continued stays and support services.
Conducts reviews of patient charts for completeness of documentation in support of active psychiatric care or general psychiatric care.
Prepares reports of chart deficiency findings and submits to treatment units for correction. Follows up to ensure corrections are made.
Conducts chart reviews to ensure compliance with Federal, State and licensing agency standards and third party payer regulations.
Communicates with responsible department heads, unit directors, utilization review physician advisors and the committee to ensure the identification of inappropriate allocations of hospital resources and initiates corrective actions.
Initiates denial and reinstatement letters to notify patients, family and third party payers that level of care has been changed affecting payment process.
Maintains records of charts reviewed and deficiencies identified.

Job Requirements:

JOB REQUIREMENTS for Utilization Reviewer**Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

Six months experience in analyzing and evaluating professional services for direct patient care such as medical or clinical services, social services, psychology, physical therapy, occupational therapy, or nursing services.
Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
Six months experience in using an automated information system to enter, update, modify, delete, retrieve/inquire and report on data.
Six months experience in narrative report writing.
Knowledge of alcohol, drug and mental health treatment programs.
Knowledge of developing policies or procedures.

Conditions of Hire:

Criminal background check:
A satisfactory criminal background check is required as a condition of hire.

The recruiting agency may require the applicant to pay for the criminal background check as part of the conditional offer of hire.

Pre-employment

Drug Testing:
Upon a conditional offer, you must undergo pre-employment drug testing as part of the hiring process.

Applicants must provide proof of negative Tuberculosis test within the last 12 months before start date.

Applicants must be legally authorized to work in the United States.

The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

For more information refer to our Job Seeker Resources.

DHSS does not provide employment-based sponsorship.

Benefits:

Selection Process:

Accommodations:

The State of Delaware is an Equal Opportunity employer and values a diverse workforce.

We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.