Utilization Review Coordinator - Philadelphia, United States - Malvern Constitution Llc

Description

Malvern Behavioral Health is currently seeking a full time Utilization Management Coordinator for our brand new Acute Inpatient units location in South Philadelphia 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.


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 preestablished 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 misutilization.
• 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, highquality 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.

Supervisory Responsibilities:
None

Benefits
This position is a full time, benefit eligible position.

Benefits offered include, but not limited to:

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Paid Time Off
• 401K plan with company match

Qualifications:

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.

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Education/Experience:


Education and/or Experience:
Master's Degree or graduate of an accredited nursing program with licensure in the state of Pennsylvania. Previous utilization review experience preferred.


Technical/Computer Skills:

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.


Work Environment and Hazards:

Risk of exposure to communicable disease. Possible exposure to intoxicated, disruptive, and/or agitated patients. Protected from weather conditions.


Physical Requirements:

Sedentary work primarily - lifting 10 lbs. maximum
- _Malvern Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws._

• This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.*_