- Review all patients admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures.
- Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria.
- Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services.
- Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices.
- Contacts physicians and primary Nurses for clarification of information as necessary.
- Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies.
- Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested.
- Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated.
- Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues.
- Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings.
- Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups.
- Performs special projects or other related work as required or requested.
- Shows ability to communicate in a clear and concise manner.
- 401(k)
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- 8 hour shift
- Day shift
- Monday to Friday
- High school or equivalent (Required)
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Utilization Review Specialist - Port St Lucie, United States - Port St Lucie Behavioral Hospital
Description
The Utilization Review Coordinator utilizes the nursing process with individual patients and groups of patients to assist them in meeting their physiological, psychological, safety, and general health needs.
Knowledge of Medical Records procedures, medical terminology and office practices.
Knowledge of hospital utilization review policies and processes.
Ability to use data collection techniques, and statistical computations.
Ability to communicate effectively and professionally with third party insurance agencies.
Knowledge of DSM and criteria for meeting diagnoses.
Thorough knowledge of effective and appropriate charting principles.
*Education:
Associates degree preferred, min two years experience in a mental health setting.
Experience:
One (1) year of experience in psychiatric and/or chemical dependency preferred.
Job Type:
Full-time
Benefits:
Schedule:
Education:
Experience:
Utilization Review: 1 year (Preferred)
* mental health: 1 year (Required)
* detox: 1 year (Required)
* precertification: 1 year (Preferred)
Work Location:
In person
